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NPI Code Detail

MEDICARE: SUSAN E RIVARD-DIBENEDETTO PA C

MEDICARE: SUSAN E RIVARD-DIBENEDETTO PA C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA10003271WA
2363A00000XPhysician AssistantPA151129OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265493399
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN E RIVARD-DIBENEDETTO PA C
Provider Business Mailing Address
First Line : PO BOX 3777
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3777
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2850 SE POWELL VALLEY RD
Second Line :
City : GRESHAM
State : OR
Zip : 97080-1494
Country : US
Telephone Number : 503-666-5050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2006
Last Update Date : 02/10/2017

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Directions to “ SUSAN E RIVARD-DIBENEDETTO PA C” Practice Location

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