Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 47535 | MN |
N | 111NI0900X | Internist | 47535 | MN |
Y | 207RG0100X | Gastroenterologist | MD160372 | OR |
NPI | 1013959535 |
---|---|
Provider Name | Ranjan Charles Victor Mascarenhas |
First Address | Portland, OR 97239-2964 |
Second Address | Portland, OR 97239-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 19/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I29466 | (02) | MN |