1841279601 NPI number — RADU H TEODORESCU MD

Table of content: RADU H TEODORESCU MD (NPI 1841279601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841279601 NPI number — RADU H TEODORESCU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEODORESCU
Provider First Name:
RADU
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841279601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3158
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97208-3158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10202 SE 32ND AVE
Provider Second Line Business Practice Location Address:
STE 701
Provider Business Practice Location Address City Name:
MILWAUKIE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97222-3610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-513-1410
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  2003008020 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 04-32929 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: MD179433 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500715955 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200540710A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209023803 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106983 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: P01765514 . This is a "RR MEDICARE (PH&S)-PMG" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1050505001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00056349 . This is a "TRAVELERS MEDICARE" identifier . This identifiers is of the category "OTHER".




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