Provider Demographics
NPI:1497744684
Name:BURNSIDE, LEE (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:BURNSIDE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2047
Mailing Address - Country:US
Mailing Address - Phone:425-224-2144
Mailing Address - Fax:425-341-9653
Practice Address - Street 1:64 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2047
Practice Address - Country:US
Practice Address - Phone:888-663-6331
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033954207R00000X
WAMD33954207RH0002X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00307116OtherRAILROAD MC # VM
WA8205866Medicaid
WA0039581OtherLABOR AND INDUSTRIES # VM
WA9385BUOtherBLUE SHIELD # VM
WAUS5478718OtherAETNA SPECIALIST PIN # VM
WA8859661Medicare PIN
WA8205866Medicaid
WA9385BUOtherBLUE SHIELD # VM
WA0039581OtherLABOR AND INDUSTRIES # VM