Provider Demographics
NPI:1235300500
Name:CONSTANTINE W. PALASKAS MD PC
Entity type:Organization
Organization Name:CONSTANTINE W. PALASKAS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PALASKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-486-8088
Mailing Address - Street 1:1570 WEST ARMORY WAY STE 101
Mailing Address - Street 2:PMB # 105
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2678
Mailing Address - Country:US
Mailing Address - Phone:206-486-8088
Mailing Address - Fax:206-971-1656
Practice Address - Street 1:1221 MADISON ST STE 1410
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3555
Practice Address - Country:US
Practice Address - Phone:206-486-8088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022586207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1064799Medicaid
WAPA0925OtherREGENCE RIDER
WA217110201Medicare PIN
WAPA0925OtherREGENCE RIDER
WA1064799Medicaid