MEDICARE: MR. WILFREDO CHICAS TOVAR ENGINEER ELECTRONICS

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian	8900165	HI
2	171WV0202X	Vehicle Modifications Contractor	81713	MD
3	225XR0403X	Driving and Community Mobility Occupational Therapist
4	3418M1130X	Military or U.S. Coast Guard Water Transport Ambulance	81713	MD
5	332BC3200X	Customized Equipment (DME)	81713	MD

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1427754993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILFREDO CHICAS TOVAR ENGINEER ELECTRONICS

Provider Business Mailing Address
First Line	:	6305 23RD AVE
Second Line	:
City	:	WEST HYATTSVILLE
State	:	MD
Zip	:	20782-1744
Country	:	US
Telephone Number	:	301-257-6844
Fax Number	:

Provider Business Practice Location Address
First Line	:	6305 23RD AVE
Second Line	:
City	:	WEST HYATTSVILLE
State	:	MD
Zip	:	20782-1744
Country	:	US
Telephone Number	:	301-257-6844
Fax Number	:

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

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/06/2023

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308