Provider Demographics
NPI:1851412431
Name:TOTONCHY, MATTI ABO (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTI
Middle Name:ABO
Last Name:TOTONCHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:875 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-4655
Mailing Address - Country:US
Mailing Address - Phone:503-571-3786
Mailing Address - Fax:503-571-3772
Practice Address - Street 1:10100 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-571-3786
Practice Address - Fax:503-571-3772
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR MD08135208800000X
WAWA MD00035280208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology