Provider Demographics
NPI:1033357983
Name:EASTSIDE SURGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:EASTSIDE SURGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMEH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-455-4900
Mailing Address - Street 1:1370 116TH AVE NE STE 209
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3825
Mailing Address - Country:US
Mailing Address - Phone:425-455-4900
Mailing Address - Fax:425-455-4970
Practice Address - Street 1:1370 116TH AVE NE,
Practice Address - Street 2:SUITE 209
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3825
Practice Address - Country:US
Practice Address - Phone:425-455-4900
Practice Address - Fax:425-455-4970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030094208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8180127Medicaid
WA8180127Medicaid
WAG15856Medicare UPIN