Provider Demographics
NPI:1346276797
Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF WASHINGTON, PC
Entity Type:Organization
Organization Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF WASHINGTON, PC
Other - Org Name:DAVITA NEPHROLOGY PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-536-2615
Mailing Address - Street 1:PO BOX 9429
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9429
Mailing Address - Country:US
Mailing Address - Phone:303-626-6239
Mailing Address - Fax:866-917-5396
Practice Address - Street 1:309 BRADLEY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4381
Practice Address - Country:US
Practice Address - Phone:541-564-1810
Practice Address - Fax:541-564-1812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7126378Medicaid
WAG8851020OtherMEDICARE GROUP NUMBER
WA7126378Medicaid