MEDICARE: GAJANAN NILAVER MD

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	207R00000X	Internal Medicine Physician	MD14509	OR
2	2084N0400X	Neurology Physician	MD14509	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00479379	OTHER	OR	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386693588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAJANAN NILAVER MD

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10202 SE 32ND AVE
Second Line	:	SUITE 703
City	:	PORTLAND
State	:	OR
Zip	:	97222-3610
Country	:	US
Telephone Number	:	503-513-8020
Fax Number	:

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	10/08/2012

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Directions to “ GAJANAN NILAVER MD” Practice Location

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