BETHANY TARA SAMUELSON BANNOW (NPI# 1619267556) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619267556 |
| Entity Type | Individual |
| Full Name | BETHANY TARA SAMUELSON BANNOW |
| Credential | MD |
| Practice Address |
825 Eastlake Ave E Seattle WA 98109-4405 |
| Mailing Address |
3181 Sw Sam Jackson Park Rd # L586 Portland OR 97239-3011 |
| Practice Telephone | 2065436420 |
| Mailing Telephone | 2065436420 |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0000X |
Internal Medicine Specialization: Hematology |
OR186355 | OR | Allopathic & Osteopathic Physicians |
| N | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
MD60469202 | WA | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3303 Sw Bond Ave, Portland, OR 972394501 | 5034948534 | |
| 825 Eastlake Ave E, Seattle, WA 981094405 | 2065436420 |
| Street Address |
825 EASTLAKE AVE E |
| City | SEATTLE |
| State | WA |
| Zip Code | 98109-4405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386637288 | Stephen J Lemon | Internal Medicine | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2005-08-25 |
| 1306447834 | Saaiqa Maredia Momin | Pharmacist | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2020-11-02 |
| 1154921849 | Kenneth Tham | Pharmacist | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2020-10-30 |
| 1023625498 | Ivan Jiayong Huang | Pharmacist | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2020-09-29 |
| 1710599378 | Christine Gleason | Nurse Practitioner | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2020-08-17 |
| 1962023374 | Deeter Ryan Neumann | Pharmacist | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2020-04-27 |
| 1083234595 | Sydney Lee Smith | Pharmacist | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2020-04-24 |
| 1629698154 | Andrew Thomas Ruplin | Pharmacist | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2020-04-24 |
| 1396365300 | Kikkeri N Naresh | Pathology | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2020-04-20 |
| 1942820220 | Arianne Duong | Pharmacist | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2020-04-16 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710590179 | Direct Urgent Care Inc | Internal Medicine | 220 6th Avenue North, Seattle, WA 98109 | 2020-08-26 |
| 1073147104 | Hannah Christine Hoyt | Registered Nurse | 1354 Aloha St, Seattle, WA 98109 | 2020-02-27 |
| 1508402645 | Emily Elizabeth Rock | Counselor | Rain City Integrative Clinic, 2730 Westlake Ave N, Seattle, WA 98109 | 2019-11-25 |
| 1770048464 | Roger Leach | Massage Therapist | 4162, Roy Street, Seattle, WA 98109 | 2019-02-06 |
| 1306316658 | Laura Katie Richer | Counselor | 1817 Queen Anne Ave. N., 204, Seattle, WA 98109 | 2018-11-29 |
| 1912492828 | One Medical Group of Washington, P.C. | Psychologist | 625 Boren Avenue North, Seattle, WA 98109 | 2018-06-25 |
| 1942793526 | Washington Dental Corporation, PC | Dentist | 527 Boren Ave N, Seattle, WA 98109 | 2018-06-08 |
| 1417449968 | Chelsie Mccalla | Occupational Therapy Assistant | Mirabella, 116 Fairview Ave N, Seattle, Seattle, WA 98109 | 2018-05-31 |
| 1710405964 | Next Level Sports Performance Consulting | Clinic/Center | 24 Roy Street, #461, Seattle, WA 98109 | 2017-09-07 |
| 1679091953 | Amy Ly Indorf | Pharmacist | 825 Eastlake Ave E #msg5-90, Seattle, WA 98109 | 2017-09-06 |
| Find all providers in zip 98109 | ||||
| Taxonomy Code | 207RH0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology |
| An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, clotting disorders, sickle cell disease, hemophilia, leukemia and lymphoma. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508006347 | Adriana Carolina Bello | Internal Medicine | 4006 Pasadena Pl Ne Apt 3, Seattle, WA 98105-6461 | 2009-03-05 |
| 1164082384 | Washington Institute for Coagulation | Internal Medicine | 921 Terry Ave, Seattle, WA 98104-1239 | 2019-06-19 |
| 1891284121 | Geoffrey Roger Hill | Internal Medicine | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2018-05-02 |
| 1730696774 | Kleber Yotsumoto Fertrin | Internal Medicine | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2017-12-29 |
| 1174920953 | Jordan Gauthier | Internal Medicine | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2014-11-22 |
| 1346525979 | Laura Sophia Connelly-smith | Internal Medicine | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2011-10-14 |
| 1447581517 | Elizabeth Krakow | Internal Medicine | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2010-01-28 |
| 1881833861 | Hirohisa Nakamae | Internal Medicine | 825 Eastlake Ave E, Seattle, WA 98109-1023 | 2009-02-13 |
| 1174762223 | Dian-kun Li | Internal Medicine | 825 Eastlake Ave E, Mailstop: G4940, Seattle, WA 98109-4405 | 2009-02-12 |
| 1013160464 | Ron Ram | Internal Medicine | 825 Eastlake Ave E, Seattle, WA 98109-4405 | 2008-10-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.