Provider Demographics
NPI:1427754993
Name:TOVAR, WILFREDO CHICAS (ENGINEER ELECTRONICS)
Entity type:Individual
Prefix:MR
First Name:WILFREDO
Middle Name:CHICAS
Last Name:TOVAR
Suffix:
Gender:M
Credentials:ENGINEER ELECTRONICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1744
Mailing Address - Country:US
Mailing Address - Phone:301-257-6844
Mailing Address - Fax:
Practice Address - Street 1:6305 23RD AVE
Practice Address - Street 2:
Practice Address - City:WEST HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1744
Practice Address - Country:US
Practice Address - Phone:301-257-6844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8900165133VN1201X
MD81713171WV0202X, 3418M1130X, 332BC3200X
225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No171WV0202XOther Service ProvidersContractorVehicle Modifications
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility
No3418M1130XTransportation ServicesMilitary/U.S. Coast Guard TransportMilitary or U.S. Coast Guard Ambulance, Water Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21582009Medicaid