Healthcare Provider Details

I. General information

NPI: 1366804510
Provider Name (Legal Business Name): ARSANY BASILY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 10/07/2023
Certification Date: 10/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 116TH AVE NE
BELLEVUE WA
98004-3829
US

IV. Provider business mailing address

PO BOX 82486
KENMORE WA
98028-0486
US

V. Phone/Fax

Practice location:
  • Phone: 678-749-5252
  • Fax:
Mailing address:
  • Phone: 678-749-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60934475
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: