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1649251422

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
1	2080P0203X	Pediatric Critical Care Medicine Physician	MD25508	OR
2	208000000X	Pediatrics Physician	MD25508	OR

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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Directions to “ MARK T BUCHHOLZ MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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