| Patan Gultawatvichai, MD | |
|
9495 Sw Locust St Ste G, Portland, OR 97223-6683 | |
| (971) 314-4522 | |
| (971) 314-4527 |
| Full Name | Patan Gultawatvichai |
|---|---|
| Gender | Male |
| Speciality | Hematology/oncology |
| Experience | 17 Years |
| Location | 9495 Sw Locust St Ste G, Portland, Oregon |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720335987 | NPI | - | NPPES |
| 110115607A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RH0003X | Internal Medicine - Hematology & Oncology | MD221300 (Oregon) | Primary |
| 207RH0003X | Internal Medicine - Hematology & Oncology | 274829 (Massachusetts) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Healthalliance Hospitals, Inc | Leominster, MA | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Oncology Institute Or A Professional Corporation | 0648719989 | 3 |
| Entity Name | Oncology Institute Or A Professional Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1891536223 PECOS PAC ID: 0648719989 Enrollment ID: O20240829003590 |
| Mailing Address | Practice Location Address |
|---|---|
| Patan Gultawatvichai, MD 5 Neponset St, Worcester, MA 01606-2714 Ph: () - | Patan Gultawatvichai, MD 9495 Sw Locust St Ste G, Portland, OR 97223-6683 Ph: (971) 314-4522 |
Salona Shrestha, MD Hematology & Oncology Medicare: Accepting Medicare Assignments Practice Location: 4805 Ne Glisan St, Portland, OR 97213 Phone: 503-215-2392 | |
Dr. Emmanuel Trungtoan Tavan, MD Hematology & Oncology Medicare: Accepting Medicare Assignments Practice Location: 2800 N Vancouver Ave, Suite 230, Portland, OR 97227 Phone: 503-413-2901 | |
Ginevra Lois Liptan, M.D. Hematology & Oncology Medicare: Not Enrolled in Medicare Practice Location: 6400 Sw Canyon Ct, Ste 100, Portland, OR 97221 Phone: 503-477-9616 Fax: 503-477-9808 | |
Donald Richard Sullivan, MD Hematology & Oncology Medicare: Accepting Medicare Assignments Practice Location: 3181 Sw Sam Jackson Park Rd, Uhn67, Portland, OR 97239 Phone: 503-494-6949 | |
Dr. Victor Nguyen Pham, M.D. Hematology & Oncology Medicare: Accepting Medicare Assignments Practice Location: 9205 Sw Barnes Rd, Portland, OR 97225 Phone: 503-216-2906 | |
Richa Uppal, MD Hematology & Oncology Medicare: Accepting Medicare Assignments Practice Location: 1849 Nw Kearney St Ste 200, Portland, OR 97209 Phone: 971-229-4545 Fax: 503-966-2427 | |
Reem Hasan, MD Hematology & Oncology Medicare: Accepting Medicare Assignments Practice Location: 3181 Sw Sam Jackson Park Rd, Ppv 350, Portland, OR 97239 Phone: 503-494-8562 |