Basic Information
| Provider Information | |||||||||
| NPI: | 1700812237 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAM | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 TREMONT ST FL 6 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021085004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178045981 | ||||||||
| FaxNumber: | 6177017740 | ||||||||
| Practice Location | |||||||||
| Address1: | 64 RAINIER AVE S | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252242144 | ||||||||
| FaxNumber: | 4253419653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 09/13/2018 | ||||||||
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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 | 207R00000X | MD00034792 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | US4508822 | 01 | WA | AETNA/USHC SPECIALIST | OTHER | AD2541 | 01 | WA | BLUE SHIELD | OTHER | 0039581 | 01 | WA | LABOR & INDUSTRY | OTHER | 8246985 | 05 | WA | MEDICAID | 110211793 | 01 | RAILROAD MEDICARE | OTHER |