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General NPI Number Information
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NPI Number | 1447202247
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Entity Type | Organization
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Legal Business Name | EASTSIDE ORTHOPEDICS & SPORTS
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1601 116TH AVE NE SUITE #111
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City | BELLEVUE
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State | WA
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Zip | 98004-3010
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Country | US
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Telephone | 425-990-8300
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Fax | 425-990-8311
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Provider Business Mailing Address
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Address Line | 1601 116TH AVE NE SUITE #111
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City | BELLEVUE
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State | WA
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Zip | 98004-3010
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Country | US
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Telephone | 425-990-8300
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Fax | 425-990-8311
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | VINCENT M SANTORO
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Credential | MD
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Telephone | 425-990-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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