Healthcare Provider Details

I. General information

NPI: 1497984918
Provider Name (Legal Business Name): PRASHANT ATRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S CEDAR ST STE 301
TACOMA WA
98405-2302
US

IV. Provider business mailing address

315 MARTIN LUTHER KING JR WAY
TACOMA WA
98405
UM

V. Phone/Fax

Practice location:
  • Phone: 253-572-7320
  • Fax:
Mailing address:
  • Phone: 215-962-7192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2009013663
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60723759
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60723759
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD60723759
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: