Organization
OVERLAKE NEUROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL P. FOSMIRE M.D. (PARTNER)
(425) 709-7055
Entity
Organization
Contact information
Practice address
1135 116TH AVE NE, SUITE 200, BELLEVUE, WA 98004-4623
(425) 709-7055
(425) 709-7066
Mailing address
PO BOX 94568, SEATTLE, WA 98124-6868
(888) 846-5527
(607) 324-2369
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
602-380-699
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
182686
L & I WORKERS COMP GRP #
WA
05
—
7124977
—
WA
Enumeration date
07/08/2006
Last updated
12/03/2010
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