Healthcare Provider Details

I. General information

NPI: 1033539721
Provider Name (Legal Business Name): MATTHEW BARTINDALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21911 76TH AVE W STE 211
EDMONDS WA
98026
US

IV. Provider business mailing address

21911 76TH AVE W STE 211
EDMONDS WA
98026-7918
US

V. Phone/Fax

Practice location:
  • Phone: 425-775-6651
  • Fax: 425-670-6718
Mailing address:
  • Phone: 425-775-6651
  • Fax: 425-670-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number125065677
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberMD60934292
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD60934292
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: