Healthcare Provider Details

I. General information

NPI: 1780655001
Provider Name (Legal Business Name): CHARLES C FALZON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date: 03/23/2022
Reactivation Date: 07/28/2023

III. Provider practice location address

5608 17TH AVE NW STE 1763
SEATTLE WA
98107-5232
US

IV. Provider business mailing address

5608 17TH AVE NW STE 1763
SEATTLE WA
98107-5232
US

V. Phone/Fax

Practice location:
  • Phone: 206-773-7050
  • Fax:
Mailing address:
  • Phone: 206-773-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036138996
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301106290
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC1-0007823
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60837506
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: