Provider Demographics
NPI:1104952415
Name:RANA, VANDANA H (MD)
Entity type:Individual
Prefix:DR
First Name:VANDANA
Middle Name:H
Last Name:RANA
Suffix:
Gender:F
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:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17437 BOONES FERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-6202
Practice Address - Country:US
Practice Address - Phone:503-305-6262
Practice Address - Fax:503-305-6078
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD157912083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005376Medicaid
ORR154410Medicare PIN
ORR154409Medicare PIN