Healthcare Provider Details

I. General information

NPI: 1235498205
Provider Name (Legal Business Name): ANDA MARIA CORNEA M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC STREET BOX 356540
SEATTLE WA
98195
US

IV. Provider business mailing address

1229 MADISON ST STE 1440
SEATTLE WA
98104-3538
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-2474
  • Fax: 206-543-2958
Mailing address:
  • Phone: 206-625-0578
  • Fax: 206-625-9184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberML60293238
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD60672662
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: