Provider Demographics
NPI:1114296670
Name:ALEXANDR CHATILO, MD, PLLC
Entity Type:Organization
Organization Name:ALEXANDR CHATILO, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDR
Authorized Official - Middle Name:IVANOVICH
Authorized Official - Last Name:CHATILO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-366-5379
Mailing Address - Street 1:18526 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3821
Mailing Address - Country:US
Mailing Address - Phone:206-366-5379
Mailing Address - Fax:
Practice Address - Street 1:18526 FREMONT AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3821
Practice Address - Country:US
Practice Address - Phone:206-366-5379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044546208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty