Provider Demographics
NPI:1669641684
Name:GRANDHI, TAGORE MOHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TAGORE
Middle Name:MOHAN
Last Name:GRANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 NW SCHMIDT WAY
Mailing Address - Street 2:APT # 216
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4661
Mailing Address - Country:US
Mailing Address - Phone:503-536-7038
Mailing Address - Fax:
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:500
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-227-5050
Practice Address - Fax:503-227-2462
Is Sole Proprietor?:No
Enumeration Date:2008-02-23
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL16685390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program