Healthcare Provider Details

I. General information

NPI: 1033446802
Provider Name (Legal Business Name): BELLADONNA BREAST IMAGING CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2009
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 116TH AVE NE STE 101
BELLEVUE WA
98004-3058
US

IV. Provider business mailing address

PO BOX 84064
SEATTLE WA
98124-8464
US

V. Phone/Fax

Practice location:
  • Phone: 888-846-5527
  • Fax: 607-324-7615
Mailing address:
  • Phone: 888-846-5527
  • Fax: 607-324-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00021389
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License NumberMD00021389
License Number StateWA

VIII. Authorized Official

Name: DR. MARITA B ACHESON
Title or Position: MEMBER
Credential: MD
Phone: 888-846-5527