Healthcare Provider Details

I. General information

NPI: 1083135693
Provider Name (Legal Business Name): ON SITE DERMATOLOGY OF WASHINGTON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 STEWART ST STE 400
SEATTLE WA
98101-1217
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 877-345-5300
  • Fax: 561-989-3665
Mailing address:
  • Phone: 561-314-2000
  • Fax: 561-431-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ADAM PLOTKIN
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 561-314-2000