Provider Demographics
NPI:1669450128
Name:VIECO, PEDRO T (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:T
Last Name:VIECO
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 1:19020 33RD AVE W
Mailing Address - Street 2:STE 210
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4746
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W
Practice Address - Street 2:STE 210
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4746
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1374
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000343052085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA175981OtherL&I PROVIDER
WAP01279540OtherRR MEDICARE
WA117421OtherL&I PROVIDER
WA120222OtherL&I PROVIDER
WA8199176Medicaid
WA197515OtherL&I PROVIDER
WA204124OtherL&I PROVIDER ID
WA120222OtherL&I PROVIDER
WAE95036Medicare UPIN
WA8199176Medicaid
WAG8883639Medicare PIN
WA204124OtherL&I PROVIDER ID
WAP00754766Medicare PIN
WAP00119670Medicare PIN
WA175981OtherL&I PROVIDER
WA8862882Medicare PIN
WA300081845Medicare PIN
WAP01279540OtherRR MEDICARE