Provider Demographics
NPI:1548282783
Name:REMINGTON, BRADLEY L (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:L
Last Name:REMINGTON
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 1:12303 NE 130TH LN STE 350
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3089
Mailing Address - Country:US
Mailing Address - Phone:425-899-4400
Mailing Address - Fax:425-899-4410
Practice Address - Street 1:12303 NE 130TH LN STE 350
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3089
Practice Address - Country:US
Practice Address - Phone:425-899-4400
Practice Address - Fax:425-899-4410
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE14960Medicare UPIN