Provider Demographics
NPI:1841327822
Name:INCE, SIMONE A (MD)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:A
Last Name:INCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:19917 7TH AVE NE
Mailing Address - Street 2:STE 203
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6555
Mailing Address - Country:US
Mailing Address - Phone:360-824-5474
Mailing Address - Fax:360-326-2451
Practice Address - Street 1:19917 7TH AVE NE
Practice Address - Street 2:STE 203
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6555
Practice Address - Country:US
Practice Address - Phone:360-824-5474
Practice Address - Fax:360-326-2451
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00031070207N00000X
CO35784207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8884948OtherMEDICARE PTAN - KING CO
WAMD00116OtherAK DSHS
WAG8950100OtherWEST SOUND DERM PTAN
009245OtherKAISER-COMMERCIAL NUMBER
WA0274668OtherLABOR AND INDUSTRY
CO10434542Medicaid
WAG8883825Medicare PIN
WAMD00116OtherAK DSHS
COCK10710Medicare PIN