Crocenzi, Todd Shane

Crocenzi, Todd Shane is an individual health care provider with primary practice located at 4805 Ne Glisan St 6N40, Portland OR 97213-2933. He recently has only one registered license in Allopathic & Osteopathic Physicians / Medical Oncology, which is considered as his primary health care specialty. Crocenzi, Todd Shane can be contacted via phone (503) 215-5696.

Contact Information

Primary practice address
4805 Ne Glisan St 6N40 Portland OR 97213-2933
Phone: (503) 215-5696
Fax: (503) 215-5695
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Medical Oncology 207RX0202X MD26231 Oregon

Profile Details

NPI number 1336130806
LBN Legal business name Crocenzi, Todd Shane
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2005
Last updated Oct 29th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336130806 NPPES
Oregon MEDICAID 027918

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