Provider Demographics
NPI:1225089493
Name:DICK, SARAH ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:DICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13118 120TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3014
Mailing Address - Country:US
Mailing Address - Phone:425-298-4951
Mailing Address - Fax:425-298-4957
Practice Address - Street 1:13118 120TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3014
Practice Address - Country:US
Practice Address - Phone:425-298-4951
Practice Address - Fax:425-298-4957
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035157207N00000X
CAA80238207N00000X
PAMD428414207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI9798OtherBLUE SHIELD
WA8235731Medicaid
WA1899DIOtherBLUE SHIELD VM
WA8868554Medicare PIN
WA1899DIOtherBLUE SHIELD VM
WA8235731Medicaid
WADI9798OtherBLUE SHIELD