Basic Information
| Provider Information | |||||||||
| NPI: | 1275564155 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGOSTINI | ||||||||
| FirstName: | ROSEMARY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11511 NE 10TH ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980048578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255023589 | ||||||||
| FaxNumber: | 4255023589 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981012756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062236600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | MD00024630 | WA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1031673 | 05 | WA | MEDICAID | AG8775 | 01 | WA | PIERCE COUNTY | OTHER | 250004903 | 01 | RAILROAD MEDICARE | OTHER | AG6006 | 01 | WA | SNOHOMISH COUNTY | OTHER | AG8775 | 01 | WA | BLUE SHIELD | OTHER | US4119835 | 01 | WA | AETNA/USHC SPECIALIST | OTHER | 0039581 | 01 | WA | LABOR & INDUSTRY | OTHER |