Provider Demographics
NPI:1104029354
Name:VALIA NICHOLSON, SVATI (MD)
Entity Type:Individual
Prefix:
First Name:SVATI
Middle Name:
Last Name:VALIA NICHOLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SVATI
Other - Middle Name:M
Other - Last Name:VALIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3931 NE 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1009
Mailing Address - Country:US
Mailing Address - Phone:503-810-4391
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL16255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics