Provider Demographics
NPI:1831286467
Name:SHEINKOPF, RUSSELL H (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:H
Last Name:SHEINKOPF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N COMMERCIAL ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4446
Mailing Address - Country:US
Mailing Address - Phone:360-647-1687
Mailing Address - Fax:360-366-7234
Practice Address - Street 1:119 N COMMERCIAL ST
Practice Address - Street 2:SUITE 290
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4446
Practice Address - Country:US
Practice Address - Phone:360-647-1687
Practice Address - Fax:360-366-7234
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000301772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1019025Medicaid
WAC45867Medicare UPIN
WA115000173Medicare PIN