Provider Demographics
NPI:1417038019
Name:BELLINGHAM UROLOGY SPECIALISTS PLLC
Entity type:Organization
Organization Name:BELLINGHAM UROLOGY SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SOREN
Authorized Official - Middle Name:N
Authorized Official - Last Name:CARLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-671-9197
Mailing Address - Street 1:340 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1782
Mailing Address - Country:US
Mailing Address - Phone:360-671-9197
Mailing Address - Fax:360-676-7730
Practice Address - Street 1:340 BIRCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1782
Practice Address - Country:US
Practice Address - Phone:360-671-9197
Practice Address - Fax:360-676-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602558844208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7138879Medicaid
WAG8864655Medicare PIN
WA8864655Medicare PIN