Healthcare Provider Details

I. General information

NPI: 1740273366
Provider Name (Legal Business Name): PUGET SOUND NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 216TH ST SW STE 310
EDMONDS WA
98026-8006
US

IV. Provider business mailing address

7320 216TH ST SW SUITE 310
EDMONDS WA
98026-8006
US

V. Phone/Fax

Practice location:
  • Phone: 425-673-3800
  • Fax: 425-673-3802
Mailing address:
  • Phone: 425-673-3800
  • Fax: 425-672-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ELLEN M MODELL
Title or Position: NEUROLOGIST
Credential: MD
Phone: 425-673-3800