1720079965 NPI number — UMESH A CHITALEY MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720079965 NPI number — UMESH A CHITALEY MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CHITALEY

Provider First Name:

UMESH

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1720079965

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/16/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1003 S 5TH ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

TACOMA

Provider Business Mailing Address State Name:

WA

Provider Business Mailing Address Postal Code:

98405-4210

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

253-403-1677

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1003 S 5TH ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

TACOMA

Provider Business Practice Location Address State Name:

WA

Provider Business Practice Location Address Postal Code:

98405-4210

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

253-403-1677

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

11/04/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RH0003X , with the licence number:  45419 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RX0202X , with the licence number: MD60095011 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207RH0000X , with the licence number: MD60095011 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: HP36870 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 3600319 . This is a "MEDICA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
• Identifier: 2129260 . This is a "FIRST HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 552482200 . This is a "MEDICAL ASSISTANCE (MA)" identifier . This identifiers is of the category "OTHER".
• Identifier: 326J6CH . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 503R1CH . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 830008591 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 143366 . This is a "U-CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 1732103 . This is a "ARAZ GROUP/AMERICA'S PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 830000327 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 01033093 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".