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General NPI Number Information
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NPI Number | 1932345840
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Entity Type | Organization
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Legal Business Name | PUGET SOUND DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 12/23/2008
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 21701 76TH AVE W SUITE 302
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City | EDMONDS
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State | WA
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Zip | 98026
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Country | US
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Telephone | 425-672-1333
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Fax | 425-672-7555
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Provider Business Mailing Address
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Address Line | 21701 76TH AVE W SUITE 302
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City | EDMONDS
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State | WA
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Zip | 98026-7536
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Country | US
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Telephone | 425-672-1333
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Fax | 425-672-7555
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Authorized Official
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Title or Position | PRESIDENT
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Name | MELANIE KUECHLE
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Credential | M.D.
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Telephone | 425-672-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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