Provider Demographics
NPI:1851650097
Name:DOWLATSHAHI, SHADI (MD)
Entity Type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:DOWLATSHAHI
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 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:BTE 119
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-6101
Mailing Address - Fax:503-494-1159
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:BTE 119
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-6101
Practice Address - Fax:503-494-1159
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD177423207R00000X, 208M00000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program