Provider Demographics
NPI:1245406784
Name:FICHADIA, HETAL KUMUDCHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:HETAL
Middle Name:KUMUDCHANDRA
Last Name:FICHADIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 NE 20TH AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2895
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:9155 SW BARNES RD STE 532
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6632
Practice Address - Country:US
Practice Address - Phone:503-488-2344
Practice Address - Fax:503-488-2360
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1709062086S0122X, 208200000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026298Medicaid
OR500654757Medicaid
WA2026298Medicaid
OR181475Medicare PIN