Provider Demographics
NPI:1265473102
Name:MAGNUSON, CHAD R (MD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:R
Last Name:MAGNUSON
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:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:253-681-6626
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:2450 33RD AVE W
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-3252
Practice Address - Country:US
Practice Address - Phone:206-320-3364
Practice Address - Fax:206-320-5869
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG13568Medicare UPIN
WA8865084Medicare PIN