Healthcare Provider Details

I. General information

NPI: 1740367929
Provider Name (Legal Business Name): FIFTH AVENUE INTERNAL MEDICINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10564 5TH AVE NE STE 201
SEATTLE WA
98125-7200
US

IV. Provider business mailing address

10564 5TH AVE NE STE 201
SEATTLE WA
98125-7200
US

V. Phone/Fax

Practice location:
  • Phone: 206-367-1222
  • Fax: 206-364-2664
Mailing address:
  • Phone: 206-367-1222
  • Fax: 206-364-2664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30005722
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOP0000836
License Number StateWA

VIII. Authorized Official

Name: DR. JOSEPH THOMAS PALERMO JR.
Title or Position: OWNER
Credential: DO, MBA, FACOI
Phone: 206-367-1222