Basic Information
| Provider Information | |||||||||
| NPI: | 1679599658 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TASNEEM | ||||||||
| FirstName: | MAHMUDA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 9TH AVE | ||||||||
| Address2: | MS: M4-PFS | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981012756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065155811 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33501 1ST WAY S | ||||||||
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| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538382400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 03/11/2015 | ||||||||
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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 | MD00035750 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8223620 | 05 | WA | MEDICAID | 0039581 | 01 | WA | LABOR & INDUSTRY | OTHER | 110191487 | 01 | RAILROAD MEDICARE | OTHER | US1037417 | 01 | WA | AETNA/USHC SPECIALIST | OTHER | TA7777 | 01 | WA | BLUE SHIELD | OTHER |