Provider Demographics
NPI: | 1851444798 |
---|---|
Name: | SOLAZZI, RICHARD W (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | RICHARD |
Middle Name: | W |
Last Name: | SOLAZZI |
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: | 1229 MADISON ST. |
Mailing Address - Street 2: | SUITE 1440 |
Mailing Address - City: | SEATTLE |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98104-3538 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 206-625-0578 |
Mailing Address - Fax: | 206-625-9184 |
Practice Address - Street 1: | 1229 MADISON ST. |
Practice Address - Street 2: | SUITE 1440 |
Practice Address - City: | SEATTLE |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98104-3538 |
Practice Address - Country: | US |
Practice Address - Phone: | 206-625-0578 |
Practice Address - Fax: | 206-625-9184 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-01-22 |
Last Update Date: | 2008-10-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | MD00019397 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
050035908 | Other | RAILROAD MEDICARE MEMBER PTAN | |
WA | 8458309 | Medicaid | |
CD5550 | Other | RAILROAD MEDICARE GROUP PTAN | |
A14971 | Medicare UPIN | ||
G000156139 | Medicare PIN | ||
WA | 8458309 | Medicaid |