Healthcare Provider Details

I. General information

NPI: 1508254269
Provider Name (Legal Business Name): FERDIA BOLSTER MD, MB BCH BAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE HARBOURVIEW MEDICAL CENTER, UNIVERSITY OF WASHINGTON
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

325 9TH AVE HARBOURVIEW MEDICAL CENTER, UNIVERSITY OF WASHINGTON
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-3561
  • Fax: 206-744-8560
Mailing address:
  • Phone: 206-744-3561
  • Fax: 206-744-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberML 60522786
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: