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NPI Code Detail

MEDICARE: MARK T BUCHHOLZ MD

MEDICARE: MARK T BUCHHOLZ MD
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
12080P0203XPediatric Critical Care Medicine PhysicianMD25508OR
2208000000XPediatrics PhysicianMD25508OR

General Provider Information

NPI Number : 1649251422
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK T BUCHHOLZ MD
Provider Business Mailing Address
First Line : PO BOX 821350
Second Line :
City : VANCOUVER
State : WA
Zip : 98682-0030
Country : US
Telephone Number : 503-283-5220
Fax Number : 503-283-9527
Provider Business Practice Location Address
First Line : 2801 N GANTENBEIN AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97227-1623
Country : US
Telephone Number : 503-283-5220
Fax Number : 503-283-9527
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 12/16/2022

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