Healthcare Provider Details

I. General information

NPI: 1902870827
Provider Name (Legal Business Name): OVERLAKE IMAGING ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 116TH AVE NE STE 212
BELLEVUE WA
98004-3821
US

IV. Provider business mailing address

PO BOX 24226
SEATTLE WA
98124-0226
US

V. Phone/Fax

Practice location:
  • Phone: 425-502-8362
  • Fax:
Mailing address:
  • Phone: 877-556-1057
  • Fax: 800-508-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: MARK J PFLEGER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 425-502-8362