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NPI Code Detail

MEDICARE: OREGON CARDIOLOGY CLINIC PC

MEDICARE: OREGON CARDIOLOGY CLINIC PC
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
1207RC0000XCardiovascular Disease PhysicianMD05410OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881701381
Entity Type Code : Organization
Provider Name (Legal Business Name) : OREGON CARDIOLOGY CLINIC PC
Provider Business Mailing Address
First Line : 501 N GRAHAM ST
Second Line : SUITE 400
City : PORTLAND
State : OR
Zip : 97227-2006
Country : US
Telephone Number : 503-288-8385
Fax Number : 503-288-6789
Provider Business Practice Location Address
First Line : 501 N GRAHAM ST
Second Line : SUITE 400
City : PORTLAND
State : OR
Zip : 97227-2006
Country : US
Telephone Number : 503-288-8385
Fax Number : 503-288-6789
Authorized Official
Title or Position : PRESIDENT
Name : LEONARD MARVIN GOLDBERG
Credential : MD
Telephone Number : 503-288-8385
Provider Enumeration Date : 08/23/2006
Last Update Date : 08/22/2020

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