Healthcare Provider Details

I. General information

NPI: 1215497557
Provider Name (Legal Business Name): MARIAM RATIANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 NE 11TH AVE
PORTLAND OR
97211-4203
US

IV. Provider business mailing address

5705 NE 11TH AVE
PORTLAND OR
97211-4203
US

V. Phone/Fax

Practice location:
  • Phone: 585-481-0052
  • Fax:
Mailing address:
  • Phone: 585-481-0052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD218296
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: