Provider Demographics
NPI:1932345840
Name:PUGET SOUND DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:PUGET SOUND DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUECHLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-672-1333
Mailing Address - Street 1:21701 76TH AVE W
Mailing Address - Street 2:SUITE 302
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7536
Mailing Address - Country:US
Mailing Address - Phone:425-672-1333
Mailing Address - Fax:425-672-7555
Practice Address - Street 1:21701 76TH AVE W
Practice Address - Street 2:SUITE 302
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-672-1333
Practice Address - Fax:425-672-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty