Provider Demographics
NPI:1285634790
Name:CHAWLA, RENU (MD)
Entity Type:Individual
Prefix:
First Name:RENU
Middle Name:
Last Name:CHAWLA
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:PO BOX 5845
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-5845
Mailing Address - Country:US
Mailing Address - Phone:425-454-5281
Mailing Address - Fax:425-990-5261
Practice Address - Street 1:1407 116TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3819
Practice Address - Country:US
Practice Address - Phone:425-990-5222
Practice Address - Fax:425-454-6153
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00038109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H01279Medicare UPIN
OR134105Medicaid
ORR106264Medicare PIN