Provider Demographics
NPI:1437154911
Name:NORTHWEST SKIN SPECIALISTS PLLC
Entity Type:Organization
Organization Name:NORTHWEST SKIN SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR, OWNER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-315-4603
Mailing Address - Street 1:1229 MADISON ST
Mailing Address - Street 2:STE 1290
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3568
Mailing Address - Country:US
Mailing Address - Phone:206-315-4603
Mailing Address - Fax:206-315-4601
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:STE 1290
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3568
Practice Address - Country:US
Practice Address - Phone:206-315-4603
Practice Address - Fax:206-315-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030950207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8802746Medicare PIN