Provider Demographics
NPI:1295882652
Name:FUREDY, RONALD LINCOLN (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LINCOLN
Last Name:FUREDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 SQUAK MOUNTAIN LOOP SW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-4418
Mailing Address - Country:US
Mailing Address - Phone:425-657-0023
Mailing Address - Fax:425-449-5938
Practice Address - Street 1:2375 SQUAK MOUNTAIN LOOP SW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-4418
Practice Address - Country:US
Practice Address - Phone:425-657-0023
Practice Address - Fax:425-449-5938
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000118582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA200687100000OtherPREMERA BLUE CROSS
WAF968OtherREGENCE BLUE SHIELD
020977OtherVALUE OPTIONS
WAG000101725Medicare ID - Type Unspecified
A66169Medicare UPIN