Provider Demographics
NPI:1225029184
Name:ABBASSIAN, SORAYA ANN (MD)
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:ANN
Last Name:ABBASSIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:ABBASSIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10373 NE HANCOCK ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3873
Mailing Address - Country:US
Mailing Address - Phone:503-253-8200
Mailing Address - Fax:503-253-8121
Practice Address - Street 1:10373 NE HANCOCK ST
Practice Address - Street 2:SUITE 117
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3873
Practice Address - Country:US
Practice Address - Phone:503-253-8200
Practice Address - Fax:503-253-8121
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286400Medicaid
OR286400Medicaid
ORR130834Medicare ID - Type Unspecified