Individual
MARY MARCELLE COSTANTINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6958 SW VARNS ST, PORTLAND, OR 97223-0000
(503) 683-7730
(503) 914-0927
Mailing address
6958 SW VARNS ST, PORTLAND, OR 97223-0000
(503) 683-7730
(503) 914-0927
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
MD26429
OR
2085R0204X
Vascular & Interventional Radiology Physician
Primary
MD26429
OR
Other
Enumeration date
09/14/2006
Last updated
01/26/2022
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