Healthcare Provider Details

I. General information

NPI: 1245233576
Provider Name (Legal Business Name): ANDRIS EDWARD RADVANY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 SQUALICUM PKWY SUITE 100
BELLINGHAM WA
98225-1940
US

IV. Provider business mailing address

709 W ORCHARD DR STE 4
BELLINGHAM WA
98225-1766
US

V. Phone/Fax

Practice location:
  • Phone: 360-756-0382
  • Fax: 360-756-5184
Mailing address:
  • Phone: 360-318-8800
  • Fax: 360-318-1085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD00037990
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: