Provider Demographics
NPI:1104058072
Name:STORELLI, DORA ANNA RENDULIC (MD)
Entity type:Individual
Prefix:MS
First Name:DORA
Middle Name:ANNA RENDULIC
Last Name:STORELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DORA
Other - Middle Name:ANNA
Other - Last Name:RENDULIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5050 NE HOYT ST STE 340
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2983
Mailing Address - Country:US
Mailing Address - Phone:503-467-7090
Mailing Address - Fax:503-546-7240
Practice Address - Street 1:500 PARNASSUS AVE # MU320-W
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2203
Practice Address - Country:US
Practice Address - Phone:415-514-3288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD182410207XS0106X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500725220Medicaid