Healthcare Provider Details

I. General information

NPI: 1922386614
Provider Name (Legal Business Name): SURESH CHAND MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 06/29/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15455 NW GREENBRIER PKWY STE 130
BEAVERTON OR
97006-8115
US

IV. Provider business mailing address

15455 NW GREENBRIER PKWY STE 130
BEAVERTON OR
97006-8115
US

V. Phone/Fax

Practice location:
  • Phone: 503-376-9200
  • Fax: 503-376-9201
Mailing address:
  • Phone: 503-376-9200
  • Fax: 503-376-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD178982
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD178982
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: