Provider Demographics
NPI:1265632541
Name:CHARLES T CHAFFEE MD
Entity Type:Organization
Organization Name:CHARLES T CHAFFEE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHAFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-435-7337
Mailing Address - Street 1:7530 204TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8912
Mailing Address - Country:US
Mailing Address - Phone:360-435-7337
Mailing Address - Fax:360-435-3510
Practice Address - Street 1:7530 204TH ST NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8912
Practice Address - Country:US
Practice Address - Phone:360-435-7337
Practice Address - Fax:360-435-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7112204Medicaid
WAGAB05507Medicare PIN