Provider Demographics
NPI:1710149430
Name:CARLOS, CASEY A (MD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:A
Last Name:CARLOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 78TH AVE SE
Mailing Address - Street 2:SUITE 958
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3094
Mailing Address - Country:US
Mailing Address - Phone:425-753-2918
Mailing Address - Fax:
Practice Address - Street 1:832 102ND AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4117
Practice Address - Country:US
Practice Address - Phone:425-753-2918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60565080207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology