OVERLAKE NEUROLOGY NPI 1730112285

NPI Information

  • NPI: 1730112285
  • Provider Name: OVERLAKE NEUROLOGY
  • Classification: Psychiatry & Neurology - 2084N0400X
  • Specialization: Neurology
  • Entity Type: Organization
  • Address: 1135 116TH AVE NE
    SUITE 200
    BELLEVUE, WA
    ZIP 98004
  • Phone: (425) 709-7055

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NPI Details

OVERLAKE NEUROLOGY is a neurology psychiatry neurology in Bellevue, WA. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. OVERLAKE NEUROLOGY NPI is 1730112285. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1135 116TH AVE NE
SUITE 200
BELLEVUE, WA
ZIP 98004-623
Phone: (425) 709-7055
Fax: (425) 709-7066

The provider's authorized official is Daniel P. Fosmire .
The authorized official title is Partner and has the following contact phone number (425) 709-7055.

The enumeration date for this NPI number is 7/8/2006 and was last updated on 12/3/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12084N0400XPsychiatry & NeurologyNeurology602-380-699WASHINGTONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17124977MEDICAIDWASHINGTON
28802336MEDICARE PINWASHINGTON
3DC0528MEDICARE PINWASHINGTON
4182686OTHERWASHINGTONL & I WORKERS COMP GRP #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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