Provider Demographics
NPI:1518042084
Name:EASTSIDE ORTHOPEDICS & SPORTS MEDICINE
Entity Type:Organization
Organization Name:EASTSIDE ORTHOPEDICS & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-656-4255
Mailing Address - Street 1:1601 116TH AVE NE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3010
Mailing Address - Country:US
Mailing Address - Phone:425-990-8300
Mailing Address - Fax:425-990-8311
Practice Address - Street 1:1601 116TH AVE NE
Practice Address - Street 2:SUITE 111
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3010
Practice Address - Country:US
Practice Address - Phone:425-990-8300
Practice Address - Fax:425-990-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8860028Medicare ID - Type UnspecifiedMEDICARE PART B GROUP #