Provider Demographics
NPI:1245233576
Name:RADVANY, ANDRIS EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRIS
Middle Name:EDWARD
Last Name:RADVANY
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 1:709 W ORCHARD DR STE 4
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:3130 SQUALICUM PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1940
Practice Address - Country:US
Practice Address - Phone:360-756-0382
Practice Address - Fax:360-756-5184
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037990208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA889975Medicare ID - Type UnspecifiedWA MEDICARE PROVIDER NO.