Individual provider Active NPI

Anna Lynn Golob, M.D.

  • Internal Medicine Physician
  • Seattle, WA
National Provider Identifier
1356503197
Registry record updated Sep 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD60170802 Issued in WA
Practice address
4245 Roosevelt Way NE
Seattle, WA 98105-6008
Phone
(206) 598-8750
NPI assigned
Jul 1, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD60170802 WA Primary

Addresses

Primary practice location

4245 Roosevelt Way NE
Seattle, WA 98105-6008

Mailing address

PO Box 50095
Seattle, WA 98145-5095
Phone (206) 909-0558

Other names 1

  • Anna Fortin Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161025002879 WA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 5597935627

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316995200000",
    "number": "1356503197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50095",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981455095",
            "telephone_number": "206-909-0558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4245 ROOSEVELT WAY NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981056008",
            "telephone_number": "206-598-8750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLOB",
        "first_name": "ANNA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-01",
        "last_updated": "2011-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60170802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNA",
            "last_name": "FORTIN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.