Provider Demographics
NPI:1740216472
Name:GOSWAMI, POMPY Z (MD)
Entity Type:Individual
Prefix:
First Name:POMPY
Middle Name:Z
Last Name:GOSWAMI
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:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:29345 SW TOWN CENTER LOOP E
Practice Address - Street 2:SUITE 110
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9465
Practice Address - Country:US
Practice Address - Phone:503-582-2100
Practice Address - Fax:503-582-2101
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027931Medicaid
ORR157187Medicare PIN
ORR133362Medicare PIN
OR027931Medicaid
ORR146062Medicare PIN