Provider Demographics
NPI:1164705489
Name:RONALD L. FUREDY, MD, PS
Entity Type:Organization
Organization Name:RONALD L. FUREDY, MD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LINCOLN
Authorized Official - Last Name:FUREDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-657-0023
Mailing Address - Street 1:2375 SQUAK MOUNTAIN LOOP SW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-4418
Mailing Address - Country:US
Mailing Address - Phone:425-657-0023
Mailing Address - Fax:425-449-5938
Practice Address - Street 1:2375 SQUAK MOUNTAIN LOOP SW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-4418
Practice Address - Country:US
Practice Address - Phone:425-657-0023
Practice Address - Fax:425-449-5938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000118582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF968OtherREGENCE BLUE SHIELD
WA020977OtherVALUE OPTIONS
WA200687100000OtherPREMERA BLUE SHIELD
WAA66169Medicare UPIN
WA200687100000OtherPREMERA BLUE SHIELD