Provider Demographics
NPI:1346593357
Name:PORTLAND NEUROLOGY & SLEEP PC
Entity Type:Organization
Organization Name:PORTLAND NEUROLOGY & SLEEP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:BEENISH
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-282-0943
Mailing Address - Street 1:501 N GRAHAM ST
Mailing Address - Street 2:SUITE 515
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1654
Mailing Address - Country:US
Mailing Address - Phone:503-282-0943
Mailing Address - Fax:503-282-2682
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:SUITE 515
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-282-0943
Practice Address - Fax:503-282-2682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO157968173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Single Specialty