Healthcare Provider Details

I. General information

NPI: 1255890216
Provider Name (Legal Business Name): BALAJI V SRIDHAR MD, PHD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 NE NORTHGATE WAY
SEATTLE WA
98125-7312
US

IV. Provider business mailing address

836 NE NORTHGATE WAY
SEATTLE WA
98125-7312
US

V. Phone/Fax

Practice location:
  • Phone: 206-784-0787
  • Fax:
Mailing address:
  • Phone: 206-784-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD.61304534
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDR.0065235
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDR.0065235
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0065235
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: