Provider Demographics
NPI:1902870827
Name:OVERLAKE IMAGING ASSOCIATES PC
Entity Type:Organization
Organization Name:OVERLAKE IMAGING ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PFLEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-502-8362
Mailing Address - Street 1:PO BOX 24226
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0226
Mailing Address - Country:US
Mailing Address - Phone:877-556-1057
Mailing Address - Fax:800-508-4751
Practice Address - Street 1:1417 116TH AVE NE STE 212
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3821
Practice Address - Country:US
Practice Address - Phone:425-502-8362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA109450OtherL&I
CD3333OtherRAILROAD MEDICARE
WA7078454Medicaid
WAG217134000Medicare PIN