MEDICARE: DR. CAROLYN COGHILL PISZCZEK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider
2	207V00000X	Obstetrics & Gynecology Physician	24857	NE
3	207V00000X	Obstetrics & Gynecology Physician	133637	CA
4	207V00000X	Obstetrics & Gynecology Physician	MD171024	OR

General Provider Information

NPI Number	:	1023161262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN COGHILL PISZCZEK M.D.

Provider Business Mailing Address
First Line	:	1050 NW 22ND AVE
Second Line	:	NORTHUP BLDG, SUITE 23
City	:	PORTLAND
State	:	OR
Zip	:	97210
Country	:	US
Telephone Number	:	503-413-7529
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 NW 22ND AVENUE, NORTHUP BLDG.,
Second Line	:	SUITE 23
City	:	PORTLAND
State	:	OR
Zip	:	97210
Country	:	US
Telephone Number	:	503-413-7529
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	02/04/2022

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Directions to “ DR. CAROLYN COGHILL PISZCZEK M.D.” Practice Location

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