Basic Information
| Provider Information | |||||||||
| NPI: | 1861578668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECKER | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50095 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981455095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065436420 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | SEATTLE CANCER CARE ALLIANCE | ||||||||
| Address2: | 825 EASTLAKE AVENUE EAST | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062881012 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 10/06/2011 | ||||||||
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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 | 207RH0000X | MD00042857 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207R00000X | MD00042857 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1861578668 | 05 | WA | MEDICAID | 0230722 | 01 | WA | L&I | OTHER | 311580 | 01 | INTERNAL ID-MOTOR VEHICLE ID | OTHER |