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NPI Code Detail

MEDICARE: DAVID P CIAVERELLA DO

MEDICARE: DAVID P CIAVERELLA DO
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
12085R0202XDiagnostic Radiology PhysicianDO22260OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2840126007OTHERORREGENCE BC/BS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4P00059728OTHERORRR MC

General Provider Information

NPI Number : 1689659047
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID P CIAVERELLA DO
Provider Business Mailing Address
First Line : PO BOX 10768
Second Line :
City : PORTLAND
State : OR
Zip : 97296-0768
Country : US
Telephone Number : 503-575-2521
Fax Number : 503-389-7997
Provider Business Practice Location Address
First Line : 2801 N GANTENBEIN AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97227-1623
Country : US
Telephone Number : 503-575-2521
Fax Number : 503-389-7997
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2005
Last Update Date : 11/01/2021

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Directions to “ DAVID P CIAVERELLA DO” Practice Location

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