Provider Demographics
NPI:1073629010
Name:PALUMBO, TODD NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:NICHOLAS
Last Name:PALUMBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 NE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1134
Mailing Address - Country:US
Mailing Address - Phone:513-256-7508
Mailing Address - Fax:
Practice Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY STE 350
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4737
Practice Address - Country:US
Practice Address - Phone:971-279-2067
Practice Address - Fax:971-302-6956
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1661982084A0401X, 2084P0800X
WAMD609353162084P0800X
CAC1618762084P0800X
OH35.0876932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine