Healthcare Provider Details

I. General information

NPI: 1174109169
Provider Name (Legal Business Name): MAXWELL KNAPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 MERIDIAN ST STE 101
BELLINGHAM WA
98225-1731
US

IV. Provider business mailing address

3560 MERIDIAN ST STE 101
BELLINGHAM WA
98225-1731
US

V. Phone/Fax

Practice location:
  • Phone: 360-527-4580
  • Fax:
Mailing address:
  • Phone: 360-527-4580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD.MD.70065365
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: