Provider Demographics
NPI:1801849849
Name:ALLERGY ASTHMA & DERMATOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:ALLERGY ASTHMA & DERMATOLOGY ASSOCIATES PC
Other - Org Name:ALLERGY ASSOCIATES, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-294-6171
Mailing Address - Street 1:2415 NE 134TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3025
Mailing Address - Country:US
Mailing Address - Phone:503-294-1866
Mailing Address - Fax:
Practice Address - Street 1:233 NW 16TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2630
Practice Address - Country:US
Practice Address - Phone:503-226-6480
Practice Address - Fax:503-294-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Multi-Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCJTTMedicare PIN
WAG115139400Medicare PIN