Provider Demographics
NPI:1154584241
Name:HEMMATI, DANA N (MD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:N
Last Name:HEMMATI
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 1:10000 SE MAIN ST STE 112
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2441
Mailing Address - Country:US
Mailing Address - Phone:503-255-3054
Mailing Address - Fax:503-255-7651
Practice Address - Street 1:505 NE 87TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1965
Practice Address - Country:US
Practice Address - Phone:360-514-7374
Practice Address - Fax:360-514-7384
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47539207RG0100X
ORMD188736207RG0100X
WAMD61139267207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ834964Medicaid
AZZ160468Medicare PIN