Provider Demographics
NPI:1336177880
Name:DERMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VIGELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-254-5267
Mailing Address - Street 1:505 NE 87TH AVENUE
Mailing Address - Street 2:BLDG B SUITE 303
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1965
Mailing Address - Country:US
Mailing Address - Phone:360-254-5267
Mailing Address - Fax:360-254-6089
Practice Address - Street 1:505 NE 87TH AVENUE
Practice Address - Street 2:BLDG B SUITE 303
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1965
Practice Address - Country:US
Practice Address - Phone:360-254-5267
Practice Address - Fax:360-254-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7065758Medicaid