Provider Demographics
NPI:1972632297
Name:MARWAHA, AMITOJ SINGH (MD)
Entity type:Individual
Prefix:
First Name:AMITOJ
Middle Name:SINGH
Last Name:MARWAHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59028
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2028
Mailing Address - Country:US
Mailing Address - Phone:425-251-5110
Mailing Address - Fax:425-793-4707
Practice Address - Street 1:4011 TALBOT RD S
Practice Address - Street 2:STE 500
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5773
Practice Address - Country:US
Practice Address - Phone:425-251-5110
Practice Address - Fax:425-793-7376
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2046-850207R00000X
WA60331807207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028478Medicaid
WA2028478Medicaid