Healthcare Provider Details

I. General information

NPI: 1447498274
Provider Name (Legal Business Name): SPENCER VASCULAR DIAGNOSTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E JEFFERSON ST SUITE 500
SEATTLE WA
98122-5698
US

IV. Provider business mailing address

1600 E JEFFERSON ST SUITE 500
SEATTLE WA
98122-5698
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-4455
  • Fax: 206-320-3160
Mailing address:
  • Phone: 206-320-4455
  • Fax: 206-320-3160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number206BC0100X
License Number StateWA

VIII. Authorized Official

Name: MR. AJAY P ZACHARIAH
Title or Position: COO
Credential:
Phone: 206-320-4400