Provider Demographics
NPI:1790759629
Name:PROW, HAROLD W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:W
Last Name:PROW
Suffix:JR
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 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
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039626174400000X, 2085N0700X, 2085R0202X
AK1090962085N0700X, 2085R0202X
IDM-134722085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2111PROtherREGENCE
WA8929685OtherCRIME VICTIMS
WA8275554Medicaid
WA147657OtherL&I
2604793OtherAETNA
WA350385OtherL&I-SWEDISH RADIA
WA1019031Medicaid
WA350383OtherL&I-RADIA REST OF WA
WA350384OtherL&I-RADIA KING COUNTY
WA350386OtherL&I-EVERGREEN RADIA
WA8929685OtherCRIME VICTIMS
WAG8948916Medicare PIN
WAG8949069Medicare PIN
2604793OtherAETNA
300120667OtherRAILROAD MEDICARE
WAG8948924Medicare PIN
WA350386OtherL&I-EVERGREEN RADIA
WAP01623675Medicare PIN
WAG8949068Medicare PIN
WAP01623681Medicare PIN