DR. MARK DAVID TILSON PH.D. NPI 1134345523

NPI Information

  • NPI: 1134345523
  • Provider Name: DR. MARK DAVID TILSON, PH.D.
  • Classification: Clinical Neuropsychologist - 103G00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1015 NW 22ND AVE
    RIO - 5 EAST
    PORTLAND, OR
    ZIP 97210
  • Phone: (503) 413-7662

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NPI Details

DR. Mark David Tilson, PH.D. is a clinical neuropsychologist in Portland, OR. The provider is a clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems. DR. Mark David Tilson, PH.D. NPI is 1134345523. 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:

1015 NW 22ND AVE
RIO - 5 EAST
PORTLAND, OR
ZIP 97210-025
Phone: (503) 413-7662
Fax: (503) 413-8103

The NPI 1134345523 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS).

The enumeration date for this NPI number is 4/17/2007 and was last updated on 7/9/2007.

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
1103G00000XClinical Neuropsychologist826OREGONYes
2103TC0700XPsychologistClinical826OREGONX
3103TR0400XPsychologistRehabilitation826OREGONX

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1R94764MEDICARE UPINOREGON
20682BBVLCMEDICARE ID-TYPE UNSPECIFIEDOREGONMEDICARE NUMBER
3079009MEDICAIDOREGON

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: 3/30/2025

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