Provider Demographics
NPI:1811058951
Name:UMOSELLA, CHARLES ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANTHONY
Last Name:UMOSELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7625 WISCONSIN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6564
Mailing Address - Country:US
Mailing Address - Phone:301-951-0420
Mailing Address - Fax:301-657-5638
Practice Address - Street 1:7625 WISCONSIN AVE STE 101
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6564
Practice Address - Country:US
Practice Address - Phone:301-951-0420
Practice Address - Fax:301-657-5038
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030484207Q00000X
DCMD14489207Q00000X
VA0101035615207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
215669156OtherCHAMPUS
MD383311900Medicaid
4088234OtherAETNA
42213304OtherBCBS OF MARYLAND
0202OtherBCBS OF THE NATIONAL CAPI
110180692OtherMEDICARE RAILROAD
1462913OtherUNITED HEALTH CARE
MD383311900Medicaid
1462913OtherUNITED HEALTH CARE