Organization
FAIRHAVEN DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS J. LANGEI MD (OWNER)
(360) 927-9042
Entity
Organization
Contact information
Practice address
3105 OLD FAIRHAVEN PKWY, SUITE 101, BELLINGHAM, WA 98225
(360) 656-6278
(360) 778-1804
Mailing address
3105 OLD FAIRHAVEN PKWY, SUITE 101, BELLINGHAM, WA 98225
(360) 778-1804
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
603616109
WA
207ND0101X
MOHS-Micrographic Surgery Physician
603616109
WA
363A00000X
Physician Assistant
603616109
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2073078
—
WA
Enumeration date
08/11/2016
Last updated
04/25/2019
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