Nisreen Fidda
Pathology (Anatomic Pathology & Clinical Pathology)

Address: 3900 Capital Mall Drive Sw, Olympia, WA 98502
Phone: 3607545858

Nisreen Fidda (NPI# 1992764880) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1992764880
Entity Type Individual
Full Name Nisreen Fidda
Credential MD
Gender Female
Practice Address 3900 Capital Mall Drive Sw
Olympia
WA 98502
Practice Telephone 3607545858
Practice Fax Number 3609562574
Mailing Address Po Box 3941
Seattle
WA 98124-3941
Mailing Telephone 3604597770
Mailing Fax Number 3604594361
Sole Proprietor No, this individual is not a Sole Proprietor
Enumeration Date 2006-03-21
Last Update Date 2007-12-18

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 207ZP0102X Pathology · Anatomic Pathology & Clinical Pathology Allopathic & Osteopathic Physicians MD00044946 WA
No 207ZP0102X Pathology · Anatomic Pathology & Clinical Pathology Allopathic & Osteopathic Physicians MD24504 OR

Other Provider Identifier

State Identifier Issuer Type Code
WA 203962 OTHER LABOR & INDUSTRIES
WA 8412462 MEDICAID

Physician Overview

NPI 1992764880
PAC ID by PECOS 2567429640
Professional Enrollment ID I20050923000611
Full Name Nisreen Fidda
Organization Legal Name CELLNETIX PATHOLOGY PLLC
Phone Number 2063862676
Gender F
Credential MD
Graduation Year 1993
Primary Specialty PATHOLOGY
Group Practice PAC ID 8224062971
Number of Group Practice Members 62
Accepts Medicare Assignment Y
Report Quality Measures Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
500024 PROVIDENCE ST PETER HOSPITAL
500019 PROVIDENCE CENTRALIA HOSPITAL
500139 CAPITAL MEDICAL CENTER
500031 GRAYS HARBOR COMMUNITY HOSPITAL
501335 ST ELIZABETH HOSPITAL

Office Location

Street Address 3900 CAPITAL MALL DRIVE SW
City OLYMPIA
State WA
Zip Code 98502

Providers in the same location

NPI Name Taxonomy Address Enumeration
1144571175 Erik C Engen Nurse Anesthetist, Certified Registered 3900 Capital Mall Drive Sw, Olympia, WA 98502-8654 2012-10-01
1386883775 Sheridan Healthcare of Washington, PC Anesthesiology 3900 Capital Mall Drive Sw, Olympia, WA 98502-8654 2009-02-10
1043279375 Jay Michael Odell Pathology 3900 Capital Mall Drive Sw, Olympia, WA 98502 2006-03-23

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1619406048 Trenton Reid Massage Therapist 2103 Harrison Ave Nw #2642, Olympia, WA 98502 2017-06-08
1053761163 Ryn Shendow Behavior Technician 3022 Saint James Ct Nw, Olympia, WA 98502 2016-06-20
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Taxonomy Information

Taxonomy Code 207ZP0102X
Grouping Allopathic & Osteopathic Physicians
Classification Pathology
Specialization Anatomic Pathology & Clinical Pathology

Taxonomy Definition

A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1811174824 Susanne Carmack Pathology 406 Black Hills Ln Sw Ste A, Olympia, WA 98502-8144 2008-01-22
1043279375 Jay Michael Odell Pathology 3900 Capital Mall Drive Sw, Olympia, WA 98502 2006-03-23
1104885425 Richard Osborn Whitten Pathology 413 Lilly Rd Ne, Providence St Peter Hospital, Olympia, WA 98506-5166 2006-03-23
1649239534 Terrence Anthony Schulte Pathology 413 Lilly Rd Ne, Providence St Peter Hospital, Olympia, WA 98506-5166 2006-03-21
1376502260 Charles A Richert Pathology 413 Lilly Rd Ne, Providence St Peter Hospital, Olympia, WA 98506-5166 2006-03-21

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1316367857 Paul Dennis Simonson Pathology Uwmc Anatomic Pathology, 1959 Ne Pacific, Box 356100, Seattle, WA 98195-0001 2014-04-23
1629413109 Paula Marie Jenkins Colon Pathology Uw Medicine Pathology 1959 Ne Pacific St, Box 357470, Seattle, WA 98195-0001 2013-05-09
1104167550 Pakc-dsl Inc Ps Pathology 550 17th Ave., Ste. 300, Seattle, WA 98122 2013-03-11
1265799407 Elizabeth Bagnulo Dacey Pathology 1225 Highland Avenue, Clarkston, WA 99403 2012-04-12
1427314665 Claire E Murphy Pathology 1959 Ne Pacific Box 356100, Uwmc Anatomic Pathology, Seattle, WA 98195-0001 2012-04-02
1295001436 Robert Farrell Kapela Pathology 5652 132nd Ave Ne, Bellevue, WA 98005-1033 2012-03-30
1790070571 Marc Omar Shokeir Pathology 336 36th St, 320, Bellingham, WA 98225-6580 2011-06-09
1801190186 Malcolm Scott Stirton Pathology 6347 Beach Dr Sw, Seattle, WA 98136-1351 2010-12-31
1063730745 Bup-jong Jennifer Kum Pathology 1124 Columbia St # 8320, Seattle, WA 98104 2010-05-05
1770727638 John Dallas Scarborough Pathology University of Washington Pathology Residency, 1959 Ne Pacific, Box 356100, Seattle, WA 98195-0001 2009-04-22
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City OLYMPIA
Zip Code 98502

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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