Healthcare Provider Details

I. General information

NPI: 1336257112
Provider Name (Legal Business Name): CHARLES WESLEY MEREDITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY VA PUGET SOUND S-116
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

1660 S. COLUMBIAN WAY VA PUGET SOUND S-116
SEATTLE WA
98108-1532
US

V. Phone/Fax

Practice location:
  • Phone: 206-277-1926
  • Fax:
Mailing address:
  • Phone: 206-277-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD00042591
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: