Provider Demographics
NPI:1740224880
Name:MATTY, MARIE E (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:MATTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2940
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-2940
Mailing Address - Country:US
Mailing Address - Phone:360-979-0569
Mailing Address - Fax:877-805-9505
Practice Address - Street 1:19980 10TH AVE NE STE 202
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6322
Practice Address - Country:US
Practice Address - Phone:360-979-0569
Practice Address - Fax:877-805-9505
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041619207VX0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
8918MAOtherREGENCE BLUE SHIELD
WA172437OtherLABOR & INDUSTRIES
WA1017760Medicaid
P00045620OtherRAILROAD MEDICARE
7810457OtherAETNA
7810457OtherAETNA
WAGAB38723Medicare PIN
WAGAB38272Medicare PIN
G8879711Medicare PIN
BM7970076OtherDEA
8918MAOtherREGENCE BLUE SHIELD
H87765Medicare UPIN
G8896341Medicare PIN
WAG8852224Medicare PIN