MEDICARE: DR. LAWRENCE A DWORKIN 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD00033764	WA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD10501	OR

General Provider Information

NPI Number	:	1649283193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE A DWORKIN M.D.

Provider Business Mailing Address
First Line	:	3762 SE HENRY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-7667
Country	:	US
Telephone Number	:	503-771-4270
Fax Number	:

Provider Business Practice Location Address
First Line	:	13705 NE AIRPORT WAY STE C
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-1048
Country	:	US
Telephone Number	:	503-258-6800
Fax Number	:	503-258-6864

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	02/04/2022

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