Basic Information
| Provider Information | |||||||||
| NPI: | 1881632420 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIAMATALI | ||||||||
| FirstName: | GAVIND | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 S J ST STE 336 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534264101 | ||||||||
| FaxNumber: | 2534266936 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 S J ST STE 336 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534264101 | ||||||||
| FaxNumber: | 2534266936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD00045977 | WA | N | Other Service Providers | Specialist | 207R00000X | MD26379 | ME | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | EMC0002355 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 31696 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD00045977 | WA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | MD00045977 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.