Basic Information
| Provider Information | |||||||||
| NPI: | 1316087018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLEISCHMAN | ||||||||
| FirstName: | SALLY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9621 RIDGETOP BLVD NW | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983838502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607823501 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19245 7TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | POULSBO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983706551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607823500 | ||||||||
| FaxNumber: | 3607823540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00041544 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | BF7952446 | 01 | DEA | OTHER | 5766FL | 01 | REGENCE BLUE SHIELD | OTHER | 240521 | 01 | WA | LABOR & INDUSTRIES | OTHER | 8317232 | 05 | WA | MEDICAID |