Provider Demographics
NPI:1740356443
Name:BANKESLY, OSAMA (MD)
Entity type:Individual
Prefix:
First Name:OSAMA
Middle Name:
Last Name:BANKESLY
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 1:6036 113TH PL SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-6331
Mailing Address - Country:US
Mailing Address - Phone:206-933-7214
Mailing Address - Fax:206-933-7005
Practice Address - Street 1:2600 SW HOLDEN ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3505
Practice Address - Country:US
Practice Address - Phone:206-933-7214
Practice Address - Fax:206-933-7005
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000451302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8854820Medicare PIN
137329Medicare UPIN