Individual
PALANIAPPAN CHIDAMBARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5251 NE GLISAN ST, BLDG A, 2ND FLOOR, PORTLAND, OR 97213-3052
(503) 215-4860
(503) 215-4839
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301081783
MI
207R00000X
Internal Medicine Physician
Primary
MD173966
OR
207RA0401X
Addiction Medicine (Internal Medicine) Physician
MD173966
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
476636810
—
MI
05
—
500690117
—
OR
Enumeration date
12/01/2006
Last updated
02/19/2021
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