Healthcare Provider Details

I. General information

NPI: 1356540314
Provider Name (Legal Business Name): PETER ANDREW MARCOVICI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 SE SUNNYSIDE RD KAISER SUNNYSIDE MEDICAL CENTER
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

57 LURLINE ST
SAN FRANCISCO CA
94122-3549
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-8656
  • Fax: 503-571-5869
Mailing address:
  • Phone: 619-964-9143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD168419
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD168419
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: