Provider Demographics
NPI:1720066269
Name:OLSSON, HAROLD E (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:E
Last Name:OLSSON
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 1:728 134TH ST SW
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5322
Mailing Address - Country:US
Mailing Address - Phone:425-297-6200
Mailing Address - Fax:425-297-6250
Practice Address - Street 1:12040 NE 128TH ST
Practice Address - Street 2:EVERGREEN HOSPITAL MEDICAL CENTER
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-899-2000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000155292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA120928OtherL&I PROVIDER NUMBER
WA187095OtherL&I PROVIDER NUMBER
WA8192502Medicaid
WA8192502Medicaid
WA187095OtherL&I PROVIDER NUMBER
WA8804727Medicare ID - Type UnspecifiedPROVIDER NUMBER
WAAB02902Medicare ID - Type UnspecifiedPROVIDER NUMBER