Provider Demographics
NPI:1669797403
Name:WINGERT, NATHANIEL CHARLES HAMM (MD)
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:CHARLES HAMM
Last Name:WINGERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:12911 120TH AVE NE STE G10
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3048
Mailing Address - Country:US
Mailing Address - Phone:425-823-4000
Mailing Address - Fax:425-821-3550
Practice Address - Street 1:12911 120TH AVE NE STE H210
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3065
Practice Address - Country:US
Practice Address - Phone:425-823-4000
Practice Address - Fax:425-821-3550
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60764406207XS0114X, 207X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2089063Medicaid