Provider Demographics
NPI:1477537512
Name:ROSENBAUM, SAHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAHAR
Middle Name:
Last Name:ROSENBAUM
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 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8756
Mailing Address - Fax:503-346-0237
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8756
Practice Address - Fax:503-346-0237
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1836592085R0001X
GA0492512085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000911336DMedicaid
GA00911336AMedicaid
GA000911336LMedicaid
GA000911336LMedicaid
GAF89863Medicare UPIN
GA000911336DMedicaid