Provider Demographics
NPI:1316087018
Name:FLEISCHMAN, SALLY S (MD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:S
Last Name:FLEISCHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:360-782-3501
Mailing Address - Fax:
Practice Address - Street 1:19245 7TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6551
Practice Address - Country:US
Practice Address - Phone:360-782-3500
Practice Address - Fax:360-782-3540
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5766FLOtherREGENCE BLUE SHIELD
WA240521OtherLABOR & INDUSTRIES
WA8317232Medicaid
WA8317232Medicaid
G8876150Medicare PIN
WAH69636Medicare UPIN
G8876151Medicare PIN
WA240521OtherLABOR & INDUSTRIES
G8876152Medicare PIN
BF7952446OtherDEA
WA8317232Medicaid