Provider Demographics
NPI:1437105384
Name:CHARUHAS, PETER A
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:CHARUHAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9155 SW BARNES RD
Mailing Address - Street 2:STE 416
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6625
Mailing Address - Country:US
Mailing Address - Phone:503-297-1600
Mailing Address - Fax:
Practice Address - Street 1:15405 SW 116TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:KING CITY
Practice Address - State:OR
Practice Address - Zip Code:97224-2600
Practice Address - Country:US
Practice Address - Phone:503-684-1583
Practice Address - Fax:503-598-8471
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20359231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR236885Medicaid