Healthcare Provider Details

I. General information

NPI: 1750229548
Provider Name (Legal Business Name): MATTHEW LOBERG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-7470
US

IV. Provider business mailing address

1959 NE PACIFIC ST BOX 357470
SEATTLE WA
98195-7470
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMDRE.ML.70115722
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: