MEDICARE: PORTLAND PHYSICIAN P.C.

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	190081	NY

General Provider Information

NPI Number	:	1821252040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTLAND PHYSICIAN P.C.

Provider Business Mailing Address
First Line	:	1299 PORTLAND AVE STE 7
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-2727
Country	:	US
Telephone Number	:	585-467-9790
Fax Number	:	585-467-9798

Provider Business Practice Location Address
First Line	:	1299 PORTLAND AVE STE 7
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-2727
Country	:	US
Telephone Number	:	585-467-9790
Fax Number	:	585-467-9798

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GULA-RANA MASOOD
Credential	:	M.D.
Telephone Number	:	585-467-9790

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	02/26/2010

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