Provider Demographics
NPI:1174895486
Name:PATRICIA A CHAROCHAK, D.O. P.S
Entity type:Organization
Organization Name:PATRICIA A CHAROCHAK, D.O. P.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAROCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:253-848-5555
Mailing Address - Street 1:8112 112TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-7815
Mailing Address - Country:US
Mailing Address - Phone:253-848-5555
Mailing Address - Fax:253-848-5922
Practice Address - Street 1:8112 112TH STREET CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-7815
Practice Address - Country:US
Practice Address - Phone:253-848-5555
Practice Address - Fax:253-848-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000826261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG00100829Medicare UPIN