Healthcare Provider Details

I. General information

NPI: 1841315744
Provider Name (Legal Business Name): EASTSIDE CARDIOLOGY ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12333 NE 130TH LANE #320
KIRKLAND WA
98034
US

IV. Provider business mailing address

12333 NE 130TH LANE #320
KIRKLAND WA
98034
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-0555
  • Fax: 425-899-1333
Mailing address:
  • Phone: 425-899-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number600-587-501
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number600-587-501
License Number StateWA

VIII. Authorized Official

Name: DR. MARK VOSSLER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 425-899-0555