Basic Information
| Provider Information | |||||||||
| NPI: | 1356314181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELLOWS | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 9TH AVE | ||||||||
| Address2: | MS: M4-PA | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981012756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065836025 | ||||||||
| FaxNumber: | 2065155886 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981012756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062236600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 04/09/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD00020788 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 204R00000X | MD00020788 | WA | Y | Allopathic & Osteopathic Physicians | Electrodiagnostic Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0039571 | 01 | WA | L & I | OTHER | 300093517 | 01 | WA | RAILROAD MEDICARE | OTHER | 805441800 | 01 | WA | IDAHO MEDICAID | OTHER | FE4333 | 01 | WA | INDIVIDUAL BLUE SHIELD | OTHER | MD788WA | 01 | WA | ALASKA MEDICAID | OTHER | 8592602 | 05 | WA | MEDICAID | US0861430 | 01 | WA | AETNA SPECIALIST PIN | OTHER |