Provider Demographics
NPI:1083817936
Name:EASTSIDE PULMONARY ASSOCIATES INC PS
Entity Type:Organization
Organization Name:EASTSIDE PULMONARY ASSOCIATES INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:LYON
Authorized Official - Last Name:MARMORSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-761-6401
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:RONALD
Mailing Address - State:WA
Mailing Address - Zip Code:98940-0088
Mailing Address - Country:US
Mailing Address - Phone:425-761-6401
Mailing Address - Fax:509-674-6896
Practice Address - Street 1:919 109TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4485
Practice Address - Country:US
Practice Address - Phone:425-646-3993
Practice Address - Fax:425-453-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013991207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0014435OtherLABOR & INDUSTRIES
WA8921640OtherL&I CRIME VICTIMS UNIT
WA5558MAOtherREGENCE BLUE SHIELD
WAM123OtherREGENCE BLUE SHIELD
WA7123961Medicaid
WA336277300OtherFEDERAL DEPT OF LABOR
WA336277300OtherFEDERAL DEPT OF LABOR
WAA05096Medicare UPIN
WA7123961Medicaid