Provider Demographics
NPI:1952673238
Name:NORTHWEST CENTER FOR UROLOGY
Entity Type:Organization
Organization Name:NORTHWEST CENTER FOR UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:PELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-289-0577
Mailing Address - Street 1:1135 116TH AVE NE
Mailing Address - Street 2:LL160
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4629
Mailing Address - Country:US
Mailing Address - Phone:425-289-0577
Mailing Address - Fax:425-289-0579
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:LL160
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4629
Practice Address - Country:US
Practice Address - Phone:425-289-0577
Practice Address - Fax:425-289-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty