Provider Demographics
NPI:1356540314
Name:MARCOVICI, PETER ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANDREW
Last Name:MARCOVICI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:57 LURLINE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3549
Mailing Address - Country:US
Mailing Address - Phone:619-964-9143
Mailing Address - Fax:
Practice Address - Street 1:10180 SE SUNNYSIDE RD
Practice Address - Street 2:KAISER SUNNYSIDE MEDICAL CENTER
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-571-8656
Practice Address - Fax:503-571-5869
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD1684192085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology