Provider Demographics
NPI:1801904925
Name:MADHAVAN, ERNEST MOHANDAS (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:MOHANDAS
Last Name:MADHAVAN
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 1:14030 NE 24TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3724
Mailing Address - Country:US
Mailing Address - Phone:425-637-3976
Mailing Address - Fax:
Practice Address - Street 1:14030 NE 24TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3724
Practice Address - Country:US
Practice Address - Phone:425-637-3976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000452702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry