Active NPI
Marco Jan Madian, LMT
- Other Technician
- Portland, OR
National Provider Identifier
1992000277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 15569
- Practice address
- 2442 SE 101St Ave
Ste 206
Portland, OR 97216-3060 - Phone
- (503) 816-4477
- NPI assigned
- Jan 19, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 15569 | OR | Primary |
Addresses
Primary practice location
2442 SE 101St Ave
Ste 206
Portland, OR 97216-3060
Mailing address
PO Box 12069
Portland, OR 97212-0069
Phone (503) 816-4477
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15569 | OR | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295395200000",
"number": "1992000277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 12069",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972120069",
"telephone_number": "503-816-4477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2442 SE 101ST AVE",
"address_2": "STE 206",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972163060",
"telephone_number": "503-816-4477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADIAN",
"first_name": "MARCO",
"middle_name": "JAN",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-01-19",
"last_updated": "2011-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "OR",
"license": "15569",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.