Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ML60019939 | WA |
N | 111NI0900X | Internist | ML60019939 | WA |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD183751 | OR |
N | 207RC0000X | Internist - Cardiovascular Disease | PG178493 | OR |
NPI | 1750547535 |
---|---|
Provider Name | Dr. Divya Uthaman Soman |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2008 |
Last Update Date | 10/02/2022 |