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1962480509

NPI Code Detail

MEDICARE: DR. LAUREN MARY TITCHENER MD

MEDICARE: DR. LAUREN MARY TITCHENER 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	207Q00000X	Family Medicine Physician	MD2007-0710	NM
2	207Q00000X	Family Medicine Physician	200200615	NC
3	207Q00000X	Family Medicine Physician	MD153935	OR

Other Identifiers

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

General Provider Information

NPI Number	:	1962480509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN MARY TITCHENER MD

Provider Business Mailing Address
First Line	:	211 SE CARUTHERS ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-4502
Country	:	US
Telephone Number	:	971-217-9008
Fax Number	:	971-260-0355

Provider Business Practice Location Address
First Line	:	703 NE HANCOCK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-3955
Country	:	US
Telephone Number	:	503-230-9875
Fax Number	:	503-331-3441

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	12/31/2024

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Directions to “ DR. LAUREN MARY TITCHENER MD” Practice Location

Language	Start Address	Practice Location

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