Provider Demographics
NPI:1255868410
Name:PORTUGUESE, ANDREW JAY (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAY
Last Name:PORTUGUESE
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 1:1100 FAIRVIEW AVE N # D5-126
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4433
Mailing Address - Country:US
Mailing Address - Phone:206-667-6656
Mailing Address - Fax:
Practice Address - Street 1:1354 ALOHA ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4404
Practice Address - Country:US
Practice Address - Phone:206-667-6656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD61185433207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program