Provider Demographics
NPI:1669565230
Name:TIRUMALI, NAGENDRA RANGANATHA RAO (MD)
Entity type:Individual
Prefix:DR
First Name:NAGENDRA
Middle Name:RANGANATHA RAO
Last Name:TIRUMALI
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 1:6983 SW BENHAM COURT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225
Mailing Address - Country:US
Mailing Address - Phone:503-246-6271
Mailing Address - Fax:503-246-6271
Practice Address - Street 1:3600 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227
Practice Address - Country:US
Practice Address - Phone:503-331-6545
Practice Address - Fax:503-331-6505
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR MD13528207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology