Basic Information
Provider Information
NPI: 1730399270
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ISENHATH
FirstName: SCOTT
MiddleName: NORMILE
NamePrefix: MR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 125 16TH AVE E
Address2:  
City: SEATTLE
State: WA
PostalCode: 981125211
CountryCode: US
TelephoneNumber: 2063263000
FaxNumber:  
Practice Location
Address1: 125 16TH AVE E
Address2:  
City: SEATTLE
State: WA
PostalCode: 981125211
CountryCode: US
TelephoneNumber: 2063263000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/23/2007
LastUpdateDate: 04/28/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/28/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ND0101XMD 60091859WAY Allopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery

No ID Information.


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