Provider Demographics
NPI:1578768255
Name:DASH, ATREYA (MD)
Entity Type:Individual
Prefix:
First Name:ATREYA
Middle Name:
Last Name:DASH
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:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:4033 TALBOT RD S
Practice Address - Street 2:STE 560
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5772
Practice Address - Country:US
Practice Address - Phone:425-656-5365
Practice Address - Fax:425-656-5325
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60406746208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1578768255Medicaid
WA8923050Medicare PIN