Provider Demographics
NPI:1477524429
Name:CLINCH, KELLY ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANDREW
Last Name:CLINCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:206-264-8689
Practice Address - Street 1:12333 NE 130TH LN
Practice Address - Street 2:SUITE 420
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7467
Practice Address - Country:US
Practice Address - Phone:425-899-5500
Practice Address - Fax:425-899-5529
Is Sole Proprietor?:No
Enumeration Date:2006-01-29
Last Update Date:2011-10-07
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Provider Licenses
StateLicense IDTaxonomies
WAMD00035757208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB24601Medicare ID - Type Unspecified
WAG97323Medicare UPIN