Provider Demographics
NPI:1174672281
Name:BELLINGHAM ASTHMA ALLERGY IMMUNOLOGY CLINIC PS
Entity Type:Organization
Organization Name:BELLINGHAM ASTHMA ALLERGY IMMUNOLOGY CLINIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKAYAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-733-5733
Mailing Address - Street 1:3015 SQUALICUM PKWY
Mailing Address - Street 2:STE 180
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1945
Mailing Address - Country:US
Mailing Address - Phone:360-733-5733
Mailing Address - Fax:360-733-1859
Practice Address - Street 1:3015 SQUALICUM PKWY
Practice Address - Street 2:STE 180
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1945
Practice Address - Country:US
Practice Address - Phone:360-733-5733
Practice Address - Fax:360-733-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA25387207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7110646Medicaid
WA7110646Medicaid
WAAB19813Medicare ID - Type Unspecified