Provider Demographics
NPI:1144339284
Name:HANLON, KATHLEEN J (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:HANLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 TALBOT RD S STE 430
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5791
Mailing Address - Country:US
Mailing Address - Phone:425-251-3454
Mailing Address - Fax:
Practice Address - Street 1:4011 TALBOT RD S STE 430
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5791
Practice Address - Country:US
Practice Address - Phone:425-251-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024791207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1023316Medicaid
WAD33720Medicare UPIN