Basic Information
| Provider Information | |||||||||
| NPI: | 1811058951 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UMOSELLA | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7625 WISCONSIN AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208146564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019510420 | ||||||||
| FaxNumber: | 3016575638 | ||||||||
| Practice Location | |||||||||
| Address1: | 7625 WISCONSIN AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208146564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019510420 | ||||||||
| FaxNumber: | 3016575038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 12/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0030484 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD14489 | DC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101035615 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 215669156 | 01 | CHAMPUS | OTHER | 383311900 | 05 | MD | MEDICAID | 4088234 | 01 | AETNA | OTHER | 42213304 | 01 | BCBS OF MARYLAND | OTHER | 0202 | 01 | BCBS OF THE NATIONAL CAPI | OTHER | 110180692 | 01 | MEDICARE RAILROAD | OTHER | 1462913 | 01 | UNITED HEALTH CARE | OTHER |