Provider Demographics
NPI:1063598662
Name:CHATTERLEY, SCOTT MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:MICHAEL
Last Name:CHATTERLEY
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 1:3253 WOOD LN
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-8400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3614 MERIDIAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1748
Practice Address - Country:US
Practice Address - Phone:360-734-2800
Practice Address - Fax:360-734-3818
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028158207ZP0102X
UT8315912-1205207ZP0102X
MT17166207ZP0102X
MI4301055568207ZP0102X
WY6168A207ZP0102X
IDM-10928207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK129235OtherMEDICAL LICENSE
WA7719909Medicaid
WAMD00028158OtherMEDICAL LICENSE