Provider Demographics
NPI:1376551002
Name:DERMATOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:SAUL
Authorized Official - Last Name:GOFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-267-2100
Mailing Address - Street 1:1730 MINOR AVENUE
Mailing Address - Street 2:STE 1000 DERMATOLOGY ASSOCIATES PLLC
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1498
Mailing Address - Country:US
Mailing Address - Phone:206-267-2100
Mailing Address - Fax:206-267-2101
Practice Address - Street 1:1730 MINOR AVENUE
Practice Address - Street 2:STE 1000 DERMATOLOGY ASSOCIATES PLLC
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1498
Practice Address - Country:US
Practice Address - Phone:206-267-2100
Practice Address - Fax:206-267-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7122237Medicaid
WAG8806099Medicare PIN