Healthcare Provider Details

I. General information

NPI: 1922591122
Provider Name (Legal Business Name): ADITYA IYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 CHERRY AVE
BREMERTON WA
98310-4229
US

IV. Provider business mailing address

2520 CHERRY AVE
BREMERTON WA
98310-4229
US

V. Phone/Fax

Practice location:
  • Phone: 360-377-3911
  • Fax: 855-206-2136
Mailing address:
  • Phone: 360-377-3911
  • Fax: 855-206-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61237945
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: