Provider Demographics
NPI:1639494842
Name:MERICKEL, CHARLES RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RYAN
Last Name:MERICKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 34245
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1245
Mailing Address - Country:US
Mailing Address - Phone:206-662-7747
Mailing Address - Fax:206-467-1470
Practice Address - Street 1:1001 SW KLICKITAT WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1161
Practice Address - Country:US
Practice Address - Phone:206-662-7747
Practice Address - Fax:206-467-1470
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60443645207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1627901Medicaid
WA2036556Medicaid
WAG8941042Medicare PIN
WAG8940238Medicare PIN