Provider Demographics
NPI:1295890234
Name:LABELLA, MATTHEW A (DPM)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:A
Last Name:LABELLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:A
Other - Last Name:LABELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:4520 42ND AVE SW
Mailing Address - Street 2:SUITE 34
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4240
Mailing Address - Country:US
Mailing Address - Phone:206-937-4700
Mailing Address - Fax:
Practice Address - Street 1:4520 42ND AVE SW
Practice Address - Street 2:SUITE 34
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4240
Practice Address - Country:US
Practice Address - Phone:206-937-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000739213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU95373Medicare UPIN
WAGAB21981Medicare ID - Type Unspecified