Provider Demographics
NPI:1821757030
Name:PARLATORE, ANSELM A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANSELM
Middle Name:A
Last Name:PARLATORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25970 SHOALWATER PL NE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346
Mailing Address - Country:US
Mailing Address - Phone:360-739-9865
Mailing Address - Fax:360-881-0810
Practice Address - Street 1:20301 BOND RD #150
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-739-9865
Practice Address - Fax:360-881-0810
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA000264852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty