Provider Demographics
NPI:1770651200
Name:CHIDAMBARAM, PALANIAPPAN (MD)
Entity Type:Individual
Prefix:
First Name:PALANIAPPAN
Middle Name:
Last Name:CHIDAMBARAM
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: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:
Mailing Address - Fax:
Practice Address - Street 1:5251 NE GLISAN ST
Practice Address - Street 2:BLDG A, 2ND FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3052
Practice Address - Country:US
Practice Address - Phone:503-215-4860
Practice Address - Fax:503-215-4839
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081783207R00000X
ORMD173966207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI476636810Medicaid
OR500690117Medicaid
H82868Medicare UPIN
OR500690117Medicaid
ORR182529Medicare PIN
ORR182525Medicare PIN
MI476636810Medicaid
ORR182533Medicare PIN
ORR182535Medicare PIN
ORR182536Medicare PIN
ORR182547Medicare PIN
ORR182534Medicare PIN
ORR182537Medicare PIN
ORR182532Medicare PIN
ORR182531Medicare PIN
ORR182549Medicare PIN