Provider Demographics
NPI:1952433765
Name:SILVERDALE PEDIATRICS
Entity Type:Organization
Organization Name:SILVERDALE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:AL AGBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-692-8588
Mailing Address - Street 1:9615 LEVIN ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383
Mailing Address - Country:US
Mailing Address - Phone:360-692-8588
Mailing Address - Fax:360-692-7030
Practice Address - Street 1:9615 LEVIN ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383
Practice Address - Country:US
Practice Address - Phone:360-692-8588
Practice Address - Fax:360-692-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7113574Medicaid