Basic Information
| Provider Information | |||||||||
| NPI: | 1245443480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHATURVEDI | ||||||||
| FirstName: | KIRAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3560 MERIDIAN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607342800 | ||||||||
| FaxNumber: | 3607343818 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 S 12TH ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982744000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605274505 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZH0000X | MD60139225 | WA | N | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZP0102X | MD60139225 | WA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 129973 | 01 | AK | MEDICAL LICENSE | OTHER | MD60139225 | 01 | WA | MEDICAL LICENSE | OTHER |