Provider Demographics
NPI:1952528499
Name:CHIRICHELLA, ELLEN H (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:H
Last Name:CHIRICHELLA
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 1:3851 PIPER ST. U340
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4627
Mailing Address - Country:US
Mailing Address - Phone:907-562-0321
Mailing Address - Fax:
Practice Address - Street 1:3851 PIPER ST. U340
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4627
Practice Address - Country:US
Practice Address - Phone:907-562-0321
Practice Address - Fax:907-562-2683
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60037738207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8919CGOtherREGENCE
P00655063OtherRAILROAD MEDICARE
WA240176OtherLABOR & INDUSTRIES
WA8523094Medicaid
9639167OtherAETNA
9639167OtherAETNA
B36295Medicare UPIN
WA8523094Medicaid
G8879001Medicare PIN
G8889371Medicare PIN
9639167OtherAETNA
P00655063OtherRAILROAD MEDICARE
G8876519Medicare PIN