Birch Bay Dermatology P.S.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD60450667 Issued in WA

Legal business name

BIRCH BAY DERMATOLOGY P.S.

Practice address

4540 Cordata Pkwy
Ste 101
Bellingham, WA 98226-8059

Phone

(360) 255-5049

Fax

(360) 778-2395

NPI assigned

Apr 21, 2015

Last updated

Apr 21, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Doug Hagensen

Title

Director of Operations

Phone

(360) 255-5049

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1429574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429574400000",
    "number": "1255728887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4540 CORDATA PKWY",
            "address_2": "STE 101",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982268059",
            "telephone_number": "360-255-5049",
            "fax_number": "360-778-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 CORDATA PKWY",
            "address_2": "STE 101",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982268059",
            "telephone_number": "360-255-5049",
            "fax_number": "360-778-2395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIRCH BAY DERMATOLOGY P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-21",
        "last_updated": "2015-04-21",
        "status": "A",
        "authorized_official_last_name": "HAGENSEN",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "360-255-5049"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WA",
            "license": "MD60450667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Aldred J Birmingham, RPH

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.