1356500995 NPI number — UNIVERSITY OF WASHINGTON

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356500995 NPI number — UNIVERSITY OF WASHINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF WASHINGTON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356500995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 E ROY ST
Provider Second Line Business Mailing Address:
APTO 304
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98102-5945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-959-7095
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1107 NE 45TH STREET
Provider Second Line Business Practice Location Address:
SUITE 440
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-4807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-959-7095
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OLIVEIRA
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
RACHID DE
Authorized Official Title or Position:
CLINICAL FELLOW
Authorized Official Telephone Number:
617-959-7095

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)