Healthcare Provider Details

I. General information

NPI: 1417219874
Provider Name (Legal Business Name): JOSHUA SCHILLING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12728 19TH AVE SE STE 200
EVERETT WA
98208
US

IV. Provider business mailing address

263 FARMINGTON AVE UCHC, DEPARTMENT OF MEDICINE
FARMINGTON CT
06030-1235
US

V. Phone/Fax

Practice location:
  • Phone: 425-225-2700
  • Fax:
Mailing address:
  • Phone: 860-679-6296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number60606328
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: