Provider Demographics
NPI:1598794240
Name:BELLEVUE UROLOGY ASSOCIATES INC PS
Entity Type:Organization
Organization Name:BELLEVUE UROLOGY ASSOCIATES INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISSMAN MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-454-8016
Mailing Address - Street 1:1135 NE 116TH AVE
Mailing Address - Street 2:SUITE 620
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-454-8016
Mailing Address - Fax:425-453-2827
Practice Address - Street 1:1135 NE 116TH AVE
Practice Address - Street 2:SUITE 620
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-454-8016
Practice Address - Fax:425-453-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015152208800000X
WAMD00022864208800000X
WAMD00034094208800000X
WAMD00022748208800000X
WAMD00040391208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7098601Medicaid
WA0629940002Medicare NSC
WA7098601Medicaid
GAB13440Medicare PIN