Provider Demographics
NPI:1801973219
Name:ROCK, TAJ MAHALIA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:TAJ
Middle Name:MAHALIA
Last Name:ROCK
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MS
Other - First Name:TAJ
Other - Middle Name:MAHALIA
Other - Last Name:CHEROKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9710 5TH AVE NE
Mailing Address - Street 2:#201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115
Mailing Address - Country:US
Mailing Address - Phone:206-604-0160
Mailing Address - Fax:
Practice Address - Street 1:12303 NE 130 LN
Practice Address - Street 2:#330 EVERGREEN DERMATOLOGY CENTER
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-899-4300
Practice Address - Fax:425-899-4305
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029104207N00000X
AK3125207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology