Basic Information
| Provider Information | |||||||||
| NPI: | 1184647711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DARDAS | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | FREDERICK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1959 NE PACIFIC ST BOX 356422 | ||||||||
| Address2: | SUITE AA522 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981956422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065432914 | ||||||||
| FaxNumber: | 2066164847 | ||||||||
| Practice Location | |||||||||
| Address1: | 1959 NE PACIFIC ST BOX 356422 | ||||||||
| Address2: | SUITE AA522 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981956422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065432914 | ||||||||
| FaxNumber: | 2066164847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 11/28/2017 | ||||||||
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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 | 207RA0001X | MD60152846 | WA | Y | 207RC0000X | 60152846 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1184647711 | 05 | WA | MEDICAID |