Provider Demographics
NPI:1598941551
Name:DOCTORS OF BELLEVUE-REDMOND, PLLC
Entity Type:Organization
Organization Name:DOCTORS OF BELLEVUE-REDMOND, PLLC
Other - Org Name:DR. BARDMAN MEDICAL OFFICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-208-0026
Mailing Address - Street 1:15710 NE 24TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2444
Mailing Address - Country:US
Mailing Address - Phone:425-208-0026
Mailing Address - Fax:425-644-3868
Practice Address - Street 1:15710 NE 24TH STREET
Practice Address - Street 2:STE C
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2444
Practice Address - Country:US
Practice Address - Phone:425-208-0026
Practice Address - Fax:425-644-3868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS OF BELLEVUE-REDMOND, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-21
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA44878261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
H02612Medicare UPIN