MEDICARE: DR. CHARLES ANTHONY UMOSELLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0030484	MD
2	207Q00000X	Family Medicine Physician	MD14489	DC
3	207Q00000X	Family Medicine Physician	0101035615	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	110180692	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	215669156	OTHER	CHAMPUS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4088234	OTHER	AETNA
4	42213304	OTHER	BCBS OF MARYLAND
5	0202	OTHER	BCBS OF THE NATIONAL CAPI
7	1462913	OTHER	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1811058951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ANTHONY UMOSELLA MD

Provider Business Mailing Address
First Line	:	7625 WISCONSIN AVE STE 101
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-6564
Country	:	US
Telephone Number	:	301-951-0420
Fax Number	:	301-657-5638

Provider Business Practice Location Address
First Line	:	7625 WISCONSIN AVE STE 101
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-6564
Country	:	US
Telephone Number	:	301-951-0420
Fax Number	:	301-657-5038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	12/11/2019

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Directions to “ DR. CHARLES ANTHONY UMOSELLA MD” Practice Location

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