Basic Information
| Provider Information | |||||||||
| NPI: | 1285621771 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLOCK | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CARLISLE | ||||||||
| OtherFirstName: | SUSAN | ||||||||
| OtherMiddleName: | S | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 515 MINOR AVE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063869500 | ||||||||
| FaxNumber: | 2065763802 | ||||||||
| Practice Location | |||||||||
| Address1: | 1229 MADISON ST | ||||||||
| Address2: | STE 1500 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981043586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063869500 | ||||||||
| FaxNumber: | 2065763802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 05/02/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD00031154 | WA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 151210 | 01 | WA | L & I | OTHER | 160053497 | 01 | WA | RR MEDICARE | OTHER | 8283657 | 05 | WA | MEDICAID |