Provider Demographics
NPI:1316962145
Name:MATHIASEN, PATRICK LEROY (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LEROY
Last Name:MATHIASEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2514 S EDMUNDS ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2045
Mailing Address - Country:US
Mailing Address - Phone:206-722-0594
Mailing Address - Fax:206-722-4484
Practice Address - Street 1:1035 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4604
Practice Address - Country:US
Practice Address - Phone:206-722-0594
Practice Address - Fax:206-722-4484
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000254272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1056142Medicaid
WABM1556109OtherPEA
WAE43389Medicare UPIN
WABM1556109OtherPEA