Provider Demographics
NPI:1689921033
Name:EKHLASSI, TIMOTHY ARASH (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ARASH
Last Name:EKHLASSI
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 1:3125 HOWE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-5634
Mailing Address - Country:US
Mailing Address - Phone:360-647-7750
Mailing Address - Fax:360-647-4290
Practice Address - Street 1:3125 HOWE PL STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5634
Practice Address - Country:US
Practice Address - Phone:360-647-7750
Practice Address - Fax:360-647-4290
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.061497207W00000X
MI4301109226207W00000X, 207WX0200X
WAMD60909090207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2118622Medicaid