Healthcare Provider Details

I. General information

NPI: 1831156025
Provider Name (Legal Business Name): SIDHARTH SHANKAR BHARDWAJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 NE 99TH AVE
PORTLAND OR
97220-9428
US

IV. Provider business mailing address

541 NE 20TH AVE STE 225
PORTLAND OR
97232-2895
US

V. Phone/Fax

Practice location:
  • Phone: 503-963-2707
  • Fax: 503-963-2802
Mailing address:
  • Phone: 503-963-2801
  • Fax: 503-963-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD150298
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: