Provider Demographics
NPI:1487016689
Name:KALODIMOS, HARRISON A (MD)
Entity Type:Individual
Prefix:
First Name:HARRISON
Middle Name:A
Last Name:KALODIMOS
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 1:604 NW RICHMOND BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3122
Mailing Address - Country:US
Mailing Address - Phone:206-533-2900
Mailing Address - Fax:206-533-2901
Practice Address - Street 1:604 NW RICHMOND BEACH RD
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3122
Practice Address - Country:US
Practice Address - Phone:206-533-2900
Practice Address - Fax:206-533-2901
Is Sole Proprietor?:No
Enumeration Date:2016-03-26
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60855811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1487016689Medicaid