Healthcare Provider Details

I. General information

NPI: 1720079965
Provider Name (Legal Business Name): UMESH A CHITALEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 S 5TH ST
TACOMA WA
98405-4210
US

IV. Provider business mailing address

1003 S 5TH ST
TACOMA WA
98405-4210
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-1677
  • Fax:
Mailing address:
  • Phone: 253-403-1677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number45419
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD60095011
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberMD60095011
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: