Provider Demographics
NPI:1366882318
Name:PESCARUS, RADU (MD)
Entity type:Individual
Prefix:DR
First Name:RADU
Middle Name:
Last Name:PESCARUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 NW 12TH AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2945
Mailing Address - Country:US
Mailing Address - Phone:971-340-7005
Mailing Address - Fax:
Practice Address - Street 1:408 NW 12TH AVE APT 304
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2945
Practice Address - Country:US
Practice Address - Phone:971-340-7005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-04
Last Update Date:2013-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORFE161875305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization