Provider Demographics
NPI:1164474227
Name:ADATIA, ALNASIR HAIDERALI (DO)
Entity Type:Individual
Prefix:DR
First Name:ALNASIR
Middle Name:HAIDERALI
Last Name:ADATIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30809 1ST AVE SOUTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:253-946-0666
Mailing Address - Fax:253-946-1362
Practice Address - Street 1:30809 1ST AVE SOUTH
Practice Address - Street 2:SUITE A
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-946-0666
Practice Address - Fax:253-946-1362
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0P00001019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA28853OtherL&I
WAA110OtherREGENIE
WA1310309Medicaid
WAA110OtherREGENIE
WA1310309Medicaid