Provider Demographics
NPI:1881871788
Name:SORAYA A ABBASSIAN MD LLC
Entity type:Organization
Organization Name:SORAYA A ABBASSIAN MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SORAYA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABBASSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-253-8200
Mailing Address - Street 1:10373 NE HANCOCK ST STE 117
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3873
Mailing Address - Country:US
Mailing Address - Phone:503-253-8200
Mailing Address - Fax:503-253-8121
Practice Address - Street 1:10373 NE HANCOCK ST STE 117
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3873
Practice Address - Country:US
Practice Address - Phone:503-253-8200
Practice Address - Fax:503-253-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23436305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286400Medicaid
ORH64490OtherUPIN
ORR130834OtherMEDICARE