Provider Demographics
NPI:1699727628
Name:ANDRIS RADVANY MD INC
Entity type:Organization
Organization Name:ANDRIS RADVANY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RADVANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-756-6980
Mailing Address - Street 1:1225 E SUNSET DR STE 145
Mailing Address - Street 2:PMB # 856
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-3554
Mailing Address - Country:US
Mailing Address - Phone:360-756-6980
Mailing Address - Fax:866-271-5690
Practice Address - Street 1:470 BIRCHWOOD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1781
Practice Address - Country:US
Practice Address - Phone:360-756-6980
Practice Address - Fax:866-271-5690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23215ZMedicare ID - Type UnspecifiedMEDICARE GROUP ID NUMBER
WA8859974Medicare ID - Type UnspecifiedWA MEDICARE PROVIDER NO.