Healthcare Provider Details

I. General information

NPI: 1679603401
Provider Name (Legal Business Name): CHAD MARION MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST STE 301
SEATTLE WA
98104
US

IV. Provider business mailing address

1200 12TH AVE S
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-505-1101
  • Fax:
Mailing address:
  • Phone: 206-621-4368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number117987
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD60090624
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: