Provider Demographics
NPI:1083063093
Name:BINGHAM, NISHAN
Entity Type:Individual
Prefix:DR
First Name:NISHAN
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SQUALICUM WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2077
Mailing Address - Country:US
Mailing Address - Phone:360-647-3377
Mailing Address - Fax:360-752-3214
Practice Address - Street 1:909 SQUALICUM WAY STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2077
Practice Address - Country:US
Practice Address - Phone:360-647-3377
Practice Address - Fax:360-752-3214
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61173115207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology