Provider Demographics
NPI:1992717078
Name:CHAROCHAK, PATRICIA ANN (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:CHAROCHAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11306 172ND ST CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9421
Mailing Address - Country:US
Mailing Address - Phone:253-307-8178
Mailing Address - Fax:253-881-1721
Practice Address - Street 1:11306 172ND ST CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-9421
Practice Address - Country:US
Practice Address - Phone:253-307-8178
Practice Address - Fax:360-893-7399
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000826204D00000X, 207Q00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA08749Medicare UPIN
WAG001000829Medicare ID - Type Unspecified