| Overlake Neurology | |
|
1135 116th Ave Ne Suite 200 Bellevue WA 98004-4623 | |
| (425) 709-7055 | |
| (425) 709-7066 |
| Full Name | Overlake Neurology |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 1135 116th Ave Ne, Bellevue, Washington |
| Authorized Official Name and Position | Daniel P. Fosmire (PARTNER) |
| Authorized Official Contact | 4257097055 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Overlake Neurology Po Box 94568 Seattle WA 98124-6868 Ph: (888) 846-5527 | Overlake Neurology 1135 116th Ave Ne Suite 200 Bellevue WA 98004-4623 Ph: (425) 709-7055 |
| NPI Number | 1730112285 |
|---|---|
| Provider Enumeration Date | 07/08/2006 |
| Last Update Date | 12/03/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730112285 | NPI | - | NPPES |
| 182686 | Other | WA | L & I WORKERS COMP GRP # |
| 7124977 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 602-380-699 (Washington) | Primary |
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