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General NPI Number Information
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NPI Number | 1740273366
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Entity Type | Organization
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Legal Business Name | PUGET SOUND NEUROLOGY
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 12/23/2014
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Provider Practice Location Address
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Address Line | 7320 216TH ST SW STE 310
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City | EDMONDS
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State | WA
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Zip | 98026-8006
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Country | US
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Telephone | 425-673-3800
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Fax | 425-673-3802
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Provider Business Mailing Address
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Address Line | 7320 216TH ST SW SUITE 310
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City | EDMONDS
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State | WA
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Zip | 98026-8006
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Country | US
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Telephone | 425-673-3800
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Fax | 425-672-3803
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Authorized Official
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Title or Position | NEUROLOGIST
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Name | ELLEN M MODELL
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Credential | MD
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Telephone | 425-673-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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