DR. ROBERT PROVENZANO MD NPI 1972505584

NPI Information

NPI: 1972505584
Provider Name: DR. ROBERT PROVENZANO, MD
Classification: Internal Medicine - 207RN0300X
Entity Type: Individual

Specialization: Nephrology

PECOS Registration: Yes

Address:
1547 NE 40TH AVE STE B
PORTLAND, OR
ZIP 97232
Phone: (855) 397-0197
Get Directions

DR. Robert Provenzano, MD is a nephrology internal medicine in Portland, OR. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. DR. Robert Provenzano, MD NPI is 1972505584. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1547 NE 40TH AVE STE B
PORTLAND, OR
ZIP 97232-862
Phone: (855) 397-0197

The NPI 1972505584 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/12/2005 and was last updated on 11/26/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RN0300X	Internal Medicine	Nephrology	M-11205	IDAHO	No
2	207RN0300X	Internal Medicine	Nephrology	4301047354	MICHIGAN	No
3	207RN0300X	Internal Medicine	Nephrology	54729	ARIZONA	No
4	207RN0300X	Internal Medicine	Nephrology	2017-00405	NORTH CAROLINA	No
5	207RN0300X	Internal Medicine	Nephrology	40429	SOUTH CAROLINA	No
6	207RN0300X	Internal Medicine	Nephrology	MD463387	PENNSYLVANIA	No
7	207RN0300X	Internal Medicine	Nephrology	ME118456	FLORIDA	No
8	207RN0300X	Internal Medicine	Nephrology	48234	COLORADO	No
9	207RN0300X	Internal Medicine	Nephrology	MD0000053388	TENNESSEE	No
10	207RN0300X	Internal Medicine	Nephrology	MD170613	OREGON	No
11	207RN0300X	Internal Medicine	Nephrology	RP047354	MICHIGAN	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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