Provider Demographics
NPI:1972597649
Name:SZCZEPANIAK, DOROTA A (MD)
Entity type:Individual
Prefix:
First Name:DOROTA
Middle Name:A
Last Name:SZCZEPANIAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 STEWART ST # 818-RC
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3311
Mailing Address - Country:US
Mailing Address - Phone:069-875-2232
Mailing Address - Fax:206-985-3177
Practice Address - Street 1:818 STEWART ST # 818-RC
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3311
Practice Address - Country:US
Practice Address - Phone:069-875-2232
Practice Address - Fax:206-985-3177
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048702A2080P0006X
WAMD.MD.614186962080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200195210Medicaid
IN000000576869OtherANTHEM PROVIDER NUMBER
ING75735Medicare UPIN
IN200195210Medicaid