Provider Demographics
NPI:1174847123
Name:MANOLIDES, ANDREW STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:STEVEN
Last Name:MANOLIDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84571
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5871
Mailing Address - Country:US
Mailing Address - Phone:425-251-5180
Mailing Address - Fax:425-656-5390
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-521-5180
Practice Address - Fax:425-656-5390
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60406441207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8943297OtherMEDICARE, DON'T KNOW WHICH IDENTIFIES FORMAT IT IS
WA1174847123Medicaid