Provider Demographics
NPI:1710059878
Name:CHIARELLO, ROBERT M (DPM PC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:CHIARELLO
Suffix:
Gender:M
Credentials:DPM PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4816 E CAMP LOWELL DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1276
Mailing Address - Country:US
Mailing Address - Phone:520-881-8640
Mailing Address - Fax:520-881-0332
Practice Address - Street 1:4816 E CAMP LOWELL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1276
Practice Address - Country:US
Practice Address - Phone:520-881-8640
Practice Address - Fax:520-881-0332
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0269213EP1101X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5898190001Medicare NSC
AZT41488Medicare UPIN