Provider Demographics
NPI:1376204719
Name:HARBOR DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:HARBOR DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-400-1202
Mailing Address - Street 1:7901 SKANSIE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8349
Mailing Address - Country:US
Mailing Address - Phone:253-400-1202
Mailing Address - Fax:253-400-1203
Practice Address - Street 1:7901 SKANSIE AVE STE 200
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8349
Practice Address - Country:US
Practice Address - Phone:253-400-1202
Practice Address - Fax:253-400-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty