Provider Demographics
NPI:1821252040
Name:PORTLAND PHYSICIAN P.C.
Entity Type:Organization
Organization Name:PORTLAND PHYSICIAN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GULA-RANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-467-9790
Mailing Address - Street 1:1299 PORTLAND AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2727
Mailing Address - Country:US
Mailing Address - Phone:585-467-9790
Mailing Address - Fax:585-467-9798
Practice Address - Street 1:1299 PORTLAND AVE STE 7
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2727
Practice Address - Country:US
Practice Address - Phone:585-467-9790
Practice Address - Fax:585-467-9798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF49721Medicare UPIN
NYDD0517Medicare PIN