Healthcare Provider Details

I. General information

NPI: 1740224880
Provider Name (Legal Business Name): MARIE E. MATTY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19980 10TH AVE NE STE 202
POULSBO WA
98370-6322
US

IV. Provider business mailing address

PO BOX 2940
POULSBO WA
98370-2940
US

V. Phone/Fax

Practice location:
  • Phone: 360-979-0569
  • Fax: 877-805-9505
Mailing address:
  • Phone: 360-979-0569
  • Fax: 877-805-9505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00041619
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD00041619
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: