Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD170906 | OR |
Y | 208600000X | Surgeon | MD170906 | OR |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD170906 | OR |
NPI | 1245406784 |
---|---|
Provider Name | Dr. Hetal Kumudchandra Fichadia |
First Address | Portland, OR 97232-2684 |
Second Address | Portland, OR 97225-6632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2008 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2026298 | (05) | WA |
500654757 | (05) | OR |