Provider Demographics
NPI:1629046222
Name:ELLIOTT, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:GUTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME769882085R0202X
WAMD 000485022085R0202X
MT114352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1092285Medicaid
WA0402042OtherL&I-SEATTLE RADIOLOGY
WA0238030OtherL&I-RADIA REST OF WA
WA0383181OtherL&I-RADIA KING COUNTY
FL256659100Medicaid
WA0327394OtherL&I-SWEDISH RADIA EDMONDS
WA0327399OtherL&I-EVERGREEN RADIA