Lauri M Tadlock, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD00021891 Issued in WA

Practice address

14030 NE 24TH St
Suite 202
Bellevue, WA 98007

Phone

(425) 454-1104

Fax

(425) 454-1290

NPI assigned

Sep 7, 2006

Last updated

Jun 28, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• North Pacific Dermatology PS

  • Ambulatory Surgical Clinic/Center
  • Renton, WA
  • NPI 1881845907
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277683200000",
    "number": "1225131865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14030 NE 24TH ST",
            "address_2": "SUITE 202",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "98007",
            "telephone_number": "425-454-1104",
            "fax_number": "425-454-1290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14030 NE 24TH ST",
            "address_2": "SUITE 202",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "98007",
            "telephone_number": "425-454-1104",
            "fax_number": "425-454-1290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TADLOCK",
        "first_name": "LAURI",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-07",
        "last_updated": "2010-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WA",
            "license": "MD00021891",
            "primary": true
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "WA",
            "license": "MD00021891",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "WA",
            "license": "MD00021891",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "070007061",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4120050",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7080237",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1087154",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "TA0069",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN9262",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• T & T Nguyen II DDS PS
• Kent Thien Ta, MD
• Elham Tabaraie, D.D.S.
• Amber Tabares, PH.D.
• Shiferaw Tadesse
• Melissa Taft
• Tai Shinohara Counseling, PLLC (Tai Shinohara Counseling)
• Gynine Takacs
• Miho Takai
• Kenyu Takamoto, DDS MSD

• Dermatology Physician in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Dermatology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.