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General NPI Number Information
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NPI Number | 1518025618
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Entity Type | Organization
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Legal Business Name | EASTSIDE PREMIER MEDICINE PLLC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 2950 NORTHUP WAY SUITE 210
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City | BELLEVUE
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State | WA
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Zip | 98004-1406
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Country | US
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Telephone | 425-284-3377
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Fax | 425-827-1040
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Provider Business Mailing Address
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Address Line | 2950 NORTHUP WAY SUITE 210
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City | BELLEVUE
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State | WA
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Zip | 98004-1406
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Country | US
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Telephone | 425-284-3377
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Fax | 425-827-1040
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Authorized Official
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Title or Position | PHYSICIAN
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Name | STACEY S. DONLAN
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Credential | M.D.
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Telephone | 425-284-3377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD00032729
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License Number State | WA
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