Active NPI
Carletta Mary Brown Vanderbilt, M.D.
- Geriatric Medicine (Internal Medicine) Physician
- Bellingham, WA
National Provider Identifier
1720047228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- MD00017168
- Practice address
- 3015 Squalicum Pkwy
Bellingham, WA 98225-1945 - Phone
- (360) 715-4186
- Fax
- (360) 715-4143
- NPI assigned
- Mar 22, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | MD00017168 | WA | Primary |
Addresses
Primary practice location
3015 Squalicum Pkwy
Bellingham, WA 98225-1945
Mailing address
PO Box 5096
Bellingham, WA 98227-5096
Phone (360) 715-4186
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720047228 | Medicaid | WA | |
| 1841907 | Medicaid | WA | |
| 4586813 | Other | WA | AETNA |
| 0167683 | Other | WA | L&I AND CRIME VICTIMS |
| 110232336 | Other | WA | RAILROAD MEDICARE |
| 7855VA | Other | WA | REGENCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290124800000",
"number": "1720047228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5096",
"city": "BELLINGHAM",
"state": "WA",
"postal_code": "982275096",
"telephone_number": "360-715-4186",
"fax_number": "360-715-4143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3015 SQUALICUM PKWY",
"city": "BELLINGHAM",
"state": "WA",
"postal_code": "982251945",
"telephone_number": "360-715-4186",
"fax_number": "360-715-4143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERBILT",
"first_name": "CARLETTA",
"middle_name": "MARY BROWN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-22",
"last_updated": "2010-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "WA",
"license": "MD00017168",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1720047228",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1841907",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4586813",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I AND CRIME VICTIMS",
"identifier": "0167683",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "110232336",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "7855VA",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bellingham, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.