Provider Demographics
NPI:1780655001
Name:FALZON, CHARLES C (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:C
Last Name:FALZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 17TH AVE NW STE 1763
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5232
Mailing Address - Country:US
Mailing Address - Phone:206-773-7050
Mailing Address - Fax:
Practice Address - Street 1:5608 17TH AVE NW STE 1763
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5232
Practice Address - Country:US
Practice Address - Phone:206-773-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2023-12-28
Deactivation Date:2022-03-23
Deactivation Code:
Reactivation Date:2023-07-28
Provider Licenses
StateLicense IDTaxonomies
IL036138996207Q00000X
MI4301106290207Q00000X
DEC1-0007823208D00000X
WAMD60837506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice