Provider Demographics
NPI:1508109539
Name:JARIWALA, RAMYA MISHRA (MD)
Entity Type:Individual
Prefix:
First Name:RAMYA
Middle Name:MISHRA
Last Name:JARIWALA
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 1:9155 SW BARNES RD STE 840
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6635
Mailing Address - Country:US
Mailing Address - Phone:503-296-7800
Mailing Address - Fax:503-291-1584
Practice Address - Street 1:9155 SW BARNES RD STE 840
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-296-7800
Practice Address - Fax:503-291-1584
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD183240208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500741210Medicaid