Provider Demographics
NPI:1841315744
Name:EASTSIDE CARDIOLOGY ASSOC
Entity type:Organization
Organization Name:EASTSIDE CARDIOLOGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-899-0555
Mailing Address - Street 1:12333 NE 130TH LANE
Mailing Address - Street 2:#320
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-899-0555
Mailing Address - Fax:
Practice Address - Street 1:12333 NE 130TH LANE
Practice Address - Street 2:#320
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-899-0555
Practice Address - Fax:425-899-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600-587-501363L00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAC49300Medicare UPIN
WAG217127400Medicare PIN
WAA04688Medicare UPIN
WAQ41810Medicare UPIN
WAF31091Medicare UPIN
WAP55776Medicare UPIN
WAS25533Medicare UPIN
CE8951Medicare PIN
WAA05078Medicare UPIN
WAA05573Medicare UPIN
WAG97437Medicare UPIN
WAH30545Medicare UPIN
WAF69559Medicare UPIN
WAP64290Medicare UPIN