Provider Demographics
NPI:1467439398
Name:HARMON, BEN HUGH (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:HUGH
Last Name:HARMON
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000380522085R0202X, 2085R0204X
AKS-60322085R0202X
ID123362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA133938OtherL&I PROVIDER NUMBER
WA133939OtherL&I PROVIDER NUMBER
WA175495OtherL&I PROVIDER NUMBER
WA205508OtherLNI PROVIDER ID
WA8248619Medicaid
ID1467439398Medicaid
WA162832OtherL&I PROVIDER NUMBER
AK1019903Medicaid
WAP01292753OtherRR MEDICARE
WAAB14534Medicare PIN
WA8857947Medicare PIN
WAP00268974Medicare PIN
WAAB14533Medicare PIN
WA175495OtherL&I PROVIDER NUMBER
AK1019903Medicaid
WA8248619Medicaid
WAP00368463Medicare PIN
WA300113749Medicare PIN
ID20005593Medicare PIN
WA133939OtherL&I PROVIDER NUMBER
WA162832OtherL&I PROVIDER NUMBER
WAG8907251Medicare PIN
WAE46614Medicare UPIN