Healthcare Provider Details

I. General information

NPI: 1578768255
Provider Name (Legal Business Name): ATREYA DASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S STE 560
RENTON WA
98055-5772
US

IV. Provider business mailing address

PO BOX 50095
SEATTLE WA
98145-5095
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-5365
  • Fax: 425-656-5325
Mailing address:
  • Phone: 206-543-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD60406746
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: