Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD00043943 | WA |
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MED-PHYS-LIC-12142 | MT |
N | 207RC0000X | Internist - Cardiovascular Disease | MD00043943 | WA |
N | 207RI0011X | Interventional Cardiology | MD00043943 | WA |
NPI | 1255381109 |
---|---|
Provider Name | Andrew Thomas Coletti |
First Address | Liberty Lake, WA 99019-0331 |
Second Address | Spokane, WA 99204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 03/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0279971 | L&I AND CRIME VICTIMS FOR PHMG (01) | WA |
1255381109 | (05) | WA |
2547CO | REGNECE BLUE SHIELD (01) | WA |
5793737 | AETNA (01) | WA |
82107 | L&I AND CRIME VICTIMS FOR SJMC (01) | WA |
8402372 | (05) | WA |
A058 | TRI WEST (TRICARE) (01) | WA |
G55925 | (02) | WA |
MD6425 | (05) | AK |