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General NPI Number Information
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NPI Number | 1447498274
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Entity Type | Organization
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Legal Business Name | SPENCER VASCULAR DIAGNOSTIC
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 1600 E JEFFERSON ST SUITE 500
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City | SEATTLE
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State | WA
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Zip | 98122-5698
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Country | US
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Telephone | 206-320-4455
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Fax | 206-320-3160
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Provider Business Mailing Address
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Address Line | 1600 E JEFFERSON ST SUITE 500
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City | SEATTLE
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State | WA
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Zip | 98122-5698
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Country | US
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Telephone | 206-320-4455
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Fax | 206-320-3160
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Authorized Official
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Title or Position | COO
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Name | MR. AJAY P ZACHARIAH
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Credential |
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Telephone | 206-320-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246XC2903X
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Taxonomy Name | Vascular Specialist/Technologist Cardiovascular
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License Number | 206BC0100X
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License Number State | WA
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