Healthcare Provider Details

I. General information

NPI: 1891986097
Provider Name (Legal Business Name): VASCULAR ASSOCIATES, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY STE 522
SEATTLE WA
98122-4325
US

IV. Provider business mailing address

801 BROADWAY STE 522
SEATTLE WA
98122-4325
US

V. Phone/Fax

Practice location:
  • Phone: 206-682-6087
  • Fax:
Mailing address:
  • Phone: 206-682-6087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number117057
License Number StateWA

VIII. Authorized Official

Name: ROMAN WONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 206-682-6087