Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301081783 | MI |
N | 111NI0900X | Internist | 4301081783 | MI |
Y | 207R00000X | Internist | MD173966 | OR |
Y | 111NI0900X | Internist | MD173966 | OR |
N | 207RA0401X | Internist - Addiction Medicine | MD173966 | OR |
NPI | 1770651200 |
---|---|
Provider Name | Palaniappan Chidambaram |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97213-3052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 19/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
476636810 | (05) | MI |
500690117 | (05) | OR |
H82868 | (02) |