Provider Demographics
NPI:1447584552
Name:FOURNIER-GOSSELIN, MARIE-PIERRE (MD)
Entity Type:Individual
Prefix:
First Name:MARIE-PIERRE
Middle Name:
Last Name:FOURNIER-GOSSELIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SW HARRISON ST
Mailing Address - Street 2:UNIT 18-C
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5338
Mailing Address - Country:US
Mailing Address - Phone:503-222-1015
Mailing Address - Fax:
Practice Address - Street 1:3303 SW BOND AVE
Practice Address - Street 2:8TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-6207
Practice Address - Fax:503-494-7161
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR150145207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery