Basic Information
Provider Information
NPI: 1821045972
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POLLARA
FirstName: TRISHA
MiddleName: LEE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3600 LIND AVE SW
Address2: STE 100
City: RENTON
State: WA
PostalCode: 980574934
CountryCode: US
TelephoneNumber: 4256565412
FaxNumber: 4256564079
Practice Location
Address1: 7203 129TH AVE SE
Address2: STE 200
City: NEWCASTLE
State: WA
PostalCode: 980561412
CountryCode: US
TelephoneNumber: 4256565428
FaxNumber: 4256565427
Other Information
ProviderEnumerationDate: 05/27/2006
LastUpdateDate: 01/21/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD00045602WAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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