Provider Demographics
NPI:1043509052
Name:PENNINGTON, MATTHEW WILLIAM (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 CONKLING PL W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-1833
Mailing Address - Country:US
Mailing Address - Phone:734-330-0488
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST BD 1469
Practice Address - Street 2:UNIVERSITY OF WASHINGTON
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6540
Practice Address - Country:US
Practice Address - Phone:734-330-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60585559207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine