Provider Demographics
NPI:1114066453
Name:SUWANJINDAR, PAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAN
Middle Name:
Last Name:SUWANJINDAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAPASSORN
Other - Middle Name:HIRANMAS
Other - Last Name:SUWANJINDAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1015 NW 22ND AVE # T100
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3025
Mailing Address - Country:US
Mailing Address - Phone:503-413-5701
Mailing Address - Fax:503-413-6411
Practice Address - Street 1:1015 NW 22ND AVE # T100
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3025
Practice Address - Country:US
Practice Address - Phone:503-413-5701
Practice Address - Fax:503-413-6411
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10833207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR012851Medicaid
WA8119810Medicaid
OR220028342Medicare PIN
ORE79297Medicare UPIN
WAG8879571Medicare PIN
OR012851Medicaid