Healthcare Provider Details

I. General information

NPI: 1083889190
Provider Name (Legal Business Name): ANIRBAN DAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E KINCAID ST
MOUNT VERNON WA
98274-4127
US

IV. Provider business mailing address

4300 BLACKSTONE WAY
BELLINGHAM WA
98226-7779
US

V. Phone/Fax

Practice location:
  • Phone: 360-428-6434
  • Fax: 360-848-4233
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00002234
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: