Provider Demographics
NPI:1447498274
Name:SPENCER VASCULAR DIAGNOSTIC
Entity type:Organization
Organization Name:SPENCER VASCULAR DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZACHARIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-320-4400
Mailing Address - Street 1:1600 E JEFFERSON ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5698
Mailing Address - Country:US
Mailing Address - Phone:206-320-4455
Mailing Address - Fax:206-320-3160
Practice Address - Street 1:1600 E JEFFERSON ST
Practice Address - Street 2:SUITE 500
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5698
Practice Address - Country:US
Practice Address - Phone:206-320-4455
Practice Address - Fax:206-320-3160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA206BC0100X246XC2903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Single Specialty