Healthcare Provider Details

I. General information

NPI: 1902819733
Provider Name (Legal Business Name): ANDREW C BECKSTROM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 MERIDIAN AVE N SUITE 503
SEATTLE WA
98133-9008
US

IV. Provider business mailing address

10700 MERIDIAN AVE N SUITE 503
SEATTLE WA
98133-9008
US

V. Phone/Fax

Practice location:
  • Phone: 206-526-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60017625
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD60017625
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: