Healthcare Provider Details

I. General information

NPI: 1881632420
Provider Name (Legal Business Name): GAVIND H. NIAMATALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S J ST STE 336
TACOMA WA
98405-4933
US

IV. Provider business mailing address

1717 S J ST STE 336
TACOMA WA
98405-4933
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-4101
  • Fax: 253-426-6936
Mailing address:
  • Phone: 253-426-4101
  • Fax: 253-426-6936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00045977
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD26379
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberEMC0002355
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00045977
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31696
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD48511
License Number StateIA
# 7
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD00045977
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: