Provider Demographics
NPI:1427260777
Name:MCELVANY, MATTHEW DEAN (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DEAN
Last Name:MCELVANY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAC
Other - Middle Name:
Other - Last Name:MCELVANY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:401 BICENTENNIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2149
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:4245 ROOSEVELT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6008
Practice Address - Country:US
Practice Address - Phone:206-598-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60270813207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1427260777Medicaid
ORMD150679OtherMEDICAL LICENSE
WA0295301OtherLABOR & INDUSTRY
WAMD60270813OtherMEDICAL LICENSE
WA8909662Medicare PIN
WA0295301OtherLABOR & INDUSTRY
WA8909662Medicare Oscar/Certification