Healthcare Provider Details

I. General information

NPI: 1366178493
Provider Name (Legal Business Name): BAYSIDE DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 MERIDIAN ST STE 200
BELLINGHAM WA
98225-1748
US

IV. Provider business mailing address

3614 MERIDIAN ST STE 200
BELLINGHAM WA
98225-1748
US

V. Phone/Fax

Practice location:
  • Phone: 360-685-7171
  • Fax: 360-282-0759
Mailing address:
  • Phone: 360-685-7171
  • Fax: 360-282-0759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN SPENCER HOYT
Title or Position: OWNER
Credential: MD
Phone: 360-685-7171