Healthcare Provider Details

I. General information

NPI: 1073629010
Provider Name (Legal Business Name): TODD NICHOLAS PALUMBO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SW BEAVERTON HILLSDALE HWY STE 350
BEAVERTON OR
97005-4737
US

IV. Provider business mailing address

3959 NE 7TH AVE
PORTLAND OR
97212-1134
US

V. Phone/Fax

Practice location:
  • Phone: 971-279-2067
  • Fax: 971-302-6956
Mailing address:
  • Phone: 513-256-7508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD166198
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD166198
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60935316
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC161876
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.087693
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: