Provider Demographics
NPI:1952368441
Name:PASQUARELLO, TIMOTHY J (PA-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:PASQUARELLO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPARTMENT 358
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:360-729-1394
Mailing Address - Fax:360-729-3053
Practice Address - Street 1:2979 SQUALICUM PKWY STE 101
Practice Address - Street 2:PEACEHEALTH CARDIOLOGY
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1813
Practice Address - Country:US
Practice Address - Phone:360-734-2700
Practice Address - Fax:360-734-8362
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA514363A00000X
WAPA60546761363A00000X
MAPA514363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS24539Medicare UPIN
MAAP0164Medicare ID - Type Unspecified