Healthcare Provider Details

I. General information

NPI: 1447202247
Provider Name (Legal Business Name): EASTSIDE ORTHOPEDICS & SPORTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 116TH AVE NE SUITE #111
BELLEVUE WA
98004-3010
US

IV. Provider business mailing address

1601 116TH AVE NE SUITE #111
BELLEVUE WA
98004-3010
US

V. Phone/Fax

Practice location:
  • Phone: 425-990-8300
  • Fax: 425-990-8311
Mailing address:
  • Phone: 425-990-8300
  • Fax: 425-990-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: VINCENT M SANTORO
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 425-990-8300