Provider Demographics
NPI:1326112426
Name:DICHARRY, DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:DICHARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 80TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:WA
Mailing Address - Zip Code:98039-4743
Mailing Address - Country:US
Mailing Address - Phone:425-208-6077
Mailing Address - Fax:
Practice Address - Street 1:851 80TH AVE NE
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:WA
Practice Address - Zip Code:98039-4743
Practice Address - Country:US
Practice Address - Phone:425-208-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000284102084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAB62098Medicare UPIN