MEDICARE: JAVAD SCOTT MASHKURI M.D.

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
1	146D00000X	Personal Emergency Response Attendant	MD21838	OR
2	207P00000X	Emergency Medicine Physician	042.0012128	VT
3	207P00000X	Emergency Medicine Physician	MD224551	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	002503501	OTHER	VT	MEDICARE PTAN LINKED TO CVMC-ER

Other Identifiers

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

General Provider Information

NPI Number	:	1518168814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVAD SCOTT MASHKURI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1189
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97339-1189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 MULLINS DR STE C1
Second Line	:
City	:	LEBANON
State	:	OR
Zip	:	97355-2868
Country	:	US
Telephone Number	:	541-451-7450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	06/26/2025

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Directions to “ JAVAD SCOTT MASHKURI M.D.” Practice Location

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