Provider Demographics
NPI:1982653788
Name:BAYSIDE VEIN & LASER CENTER, PLLC
Entity Type:Organization
Organization Name:BAYSIDE VEIN & LASER CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-739-0948
Mailing Address - Street 1:3127 BRANDYWINE WAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-3878
Mailing Address - Country:US
Mailing Address - Phone:360-739-0948
Mailing Address - Fax:
Practice Address - Street 1:3127 BRANDYWINE WAY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-3878
Practice Address - Country:US
Practice Address - Phone:360-739-0948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7133457Medicaid
WAG8859992Medicare PIN