Provider Demographics
NPI:1790103430
Name:DERMATOLOGY ARTS, PLLC
Entity Type:Organization
Organization Name:DERMATOLOGY ARTS, PLLC
Other - Org Name:DERMATOLOGY ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:P
Authorized Official - Last Name:MASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-302-2624
Mailing Address - Street 1:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-0958
Mailing Address - Country:US
Mailing Address - Phone:650-302-2624
Mailing Address - Fax:
Practice Address - Street 1:1414 116TH AVE NE STE E
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3801
Practice Address - Country:US
Practice Address - Phone:425-753-2918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207N00000X
WAMD60153580261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty