1295729010 NPI number — DR. ADRIAN EOIN OMALLEY MD

Table of content: DR. ADRIAN EOIN OMALLEY MD (NPI 1295729010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295729010 NPI number — DR. ADRIAN EOIN OMALLEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OMALLEY
Provider First Name:
ADRIAN
Provider Middle Name:
EOIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1295729010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22232 17TH AVE SE STE 308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98021-7425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-296-3837
Provider Business Mailing Address Fax Number:
206-215-3870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9800 LEVIN RD NW
Provider Second Line Business Practice Location Address:
#203
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98383-7849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-307-0300
Provider Business Practice Location Address Fax Number:
360-307-0302
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD60140589 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207WX0107X , with the licence number: MD60140589 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2006205 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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