Provider Demographics
NPI:1366178493
Name:BAYSIDE DERMATOLOGY
Entity type:Organization
Organization Name:BAYSIDE DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:HOYT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-685-7171
Mailing Address - Street 1:3614 MERIDIAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1748
Mailing Address - Country:US
Mailing Address - Phone:360-685-7171
Mailing Address - Fax:360-282-0759
Practice Address - Street 1:3614 MERIDIAN ST STE 200
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1748
Practice Address - Country:US
Practice Address - Phone:360-685-7171
Practice Address - Fax:360-282-0759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty