Healthcare Provider Details

I. General information

NPI: 1912343807
Provider Name (Legal Business Name): POORNI MANCHUREKHA MANOHAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DIVISION ST STE 220
OREGON CITY OR
97045-1527
US

IV. Provider business mailing address

1500 DIVISION ST STE 220
OREGON CITY OR
97045-1527
US

V. Phone/Fax

Practice location:
  • Phone: 503-513-1900
  • Fax:
Mailing address:
  • Phone: 503-513-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301102776
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberU4258
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberU4258
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberMD229586
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD60877995
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD229586
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: