Provider Demographics
NPI:1255652434
Name:EASTSIDE INTERNAL MEDICINE & CARDIOLOGY DAVID B FERRIN MD
Entity Type:Organization
Organization Name:EASTSIDE INTERNAL MEDICINE & CARDIOLOGY DAVID B FERRIN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:FERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-455-4841
Mailing Address - Street 1:1600 116TH AVE NE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3014
Mailing Address - Country:US
Mailing Address - Phone:425-455-4841
Mailing Address - Fax:425-450-0167
Practice Address - Street 1:1600 116TH AVE NE
Practice Address - Street 2:SUITE 206
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3014
Practice Address - Country:US
Practice Address - Phone:425-455-4841
Practice Address - Fax:425-450-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017479207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA04467Medicare UPIN