Healthcare Provider Details

I. General information

NPI: 1184299588
Provider Name (Legal Business Name): MATTHEW E. CHARLICK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 MONTLAKE BLVD # 354060
SEATTLE WA
98195-0007
US

IV. Provider business mailing address

3800 MONTLAKE BLVD
SEATTLE WA
98195-0007
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-3294
  • Fax:
Mailing address:
  • Phone: 206-598-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberDO.OP.70106184
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: