Provider Demographics
NPI:1720079965
Name:CHITALEY, UMESH A (MD)
Entity Type:Individual
Prefix:
First Name:UMESH
Middle Name:A
Last Name:CHITALEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4210
Mailing Address - Country:US
Mailing Address - Phone:253-403-1677
Mailing Address - Fax:
Practice Address - Street 1:1003 S 5TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4210
Practice Address - Country:US
Practice Address - Phone:253-403-1677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45419207RH0003X
WAMD60095011207RX0202X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP36870OtherHEALTH PARTNERS
3600319OtherMEDICA HEALTH PLANS
2129260OtherFIRST HEALTH PLAN
552482200OtherMEDICAL ASSISTANCE (MA)
326J6CHOtherBLUE CROSS BLUE SHIELD
503R1CHOtherBLUE CROSS BLUE SHIELD
830008591OtherRR MEDICARE
143366OtherU-CARE
1732103OtherARAZ GROUP/AMERICA'S PPO
830000327OtherMEDICARE
01033093OtherPREFERRED ONE
3600319OtherMEDICA HEALTH PLANS