BERT G TAVELLI (NPI# 1013918978) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013918978 |
| Entity Type | Individual |
| Full Name | BERT G TAVELLI |
| Credential | MD |
| Practice Address |
1130 Nw 22nd Ave Ste 330 Portland OR 97210-2900 |
| Practice Telephone | 5032952366 |
| Practice Fax Number | 5032953065 |
| Mailing Telephone | 5032952366 |
| Mailing Fax Number | 5032953065 |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | MD 14681 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | AT2285179 | 01 | |
| OR | 028071 | 05 |
| Street Address |
1130 NW 22ND AVE STE 330 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97210-2900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689677445 | Evonne Maria Kandas | Nurse Practitioner | 1130 Nw 22nd Ave, Suite 110, Portland, OR 97210-2900 | 2005-05-24 |
| 1346756269 | Erin P O'hollaren | Registered Nurse | 1130 Nw 22nd Ave, Portland, OR 97210-2900 | 2017-12-15 |
| 1366967879 | Vladimir Nikolayevich Chernyshev | Licensed Practical Nurse | 1130 Nw 22nd Ave, Portland, OR 97210-2900 | 2017-08-04 |
| 1659802650 | Paula J. Staab | Dietitian, Registered | 1130 Nw 22nd Ave, Suite 640, Portland, OR 97210-2900 | 2017-03-22 |
| 1447604566 | Lori Eckel | Social Worker | 1130 Nw 22nd Ave, Suite 110, Portland, OR 97210-2900 | 2016-04-14 |
| 1245660414 | Margarita Damaso-sahari | Nurse Practitioner | 1130 Nw 22nd Ave, Suite 640, Portland, OR 97210-2900 | 2013-11-25 |
| 1932464492 | Complete Anesthesia Care LLC | Nurse Anesthetist, Certified Registered | 1130 Nw 22nd Ave, Suite 615, Portland, OR 97210-2900 | 2012-07-11 |
| 1033478409 | Megan N Stack | Nurse Practitioner | 1130 Nw 22nd Ave, Suite 640, Portland, OR 97210-2900 | 2012-05-04 |
| 1730455304 | Nancy M Oswald | Social Worker | 1130 Nw 22nd Ave, Suite 345, Portland, OR 97210-2900 | 2012-03-28 |
| 1992090112 | Onyekachi Ogbonna | Internal Medicine | 1130 Nw 22nd Ave, Portland, OR 97210-2900 | 2011-06-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679109086 | Joseph Francolino | Massage Therapist | 2174 Nw Davis Street, Apartment 105, Portland, OR 97210 | 2020-03-17 |
| 1215574058 | Northwest Dbt LLC | Psychologist | 2230 Nw Pettygrove St., Suite 130, Portland, OR 97210 | 2019-11-27 |
| 1649769480 | Dipesh Patel | Student in an Organized Health Care Education/Training Program | 1200 Nw 23rd Ave. Legacy Clinic Good Samaritan, Portland, OR 97210 | 2018-05-08 |
| 1760987234 | Meghan Teague | Student in an Organized Health Care Education/Training Program | Legacy Good Samaritan Medical Center- Gme, 1015 Nw 22nd Ave, Portland, OR 97210 | 2018-03-27 |
| 1205349172 | Paul M Storm | Acupuncturist | 1708 Nw 25th Ave. Apt. #6, Portland, OR 97210 | 2017-11-14 |
| 1740703750 | Audra K Berning | Massage Therapist | 2122 Nw Quimby, Root Whole Body, Portland, OR 97210 | 2017-07-21 |
| 1720539810 | Anna-marie Elizabeth Wood | Audiologist | 2222 Nw Lovejoy St Ste 662, Portland, OR 97210 | 2016-10-24 |
| 1659829836 | H&s Pearl, LLC | Massage Therapist | 25 Nw 23rd Pl, Suite 7, Portland, OR 97210 | 2016-09-15 |
| 1255785796 | Cortez Natural Medicine, Inc. | Acupuncturist | 2230 Nw Pettygove Street, Unit 130, Portland, OR 97210 | 2016-04-21 |
| 1932563616 | Vincent Chen | Student in an Organized Health Care Education/Training Program | 1200 Nw 23rd Avenue, Legacy Clinic Good Samaritan, Portland, OR 97210 | 2016-04-08 |
| Find all providers in zip 97210 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508303561 | Carter Kroeplin Haag | Dermatology | 3303 S Bond Ave # 16d, Portland, OR 97239-4501 | 2017-01-27 |
| 1043765134 | Noelle Teske | Dermatology | 3303 S Bond Ave Fl 16, Portland, OR 97239-4501 | 2016-08-18 |
| 1134579535 | Caroline Morris | Dermatology | 3303 S Bond Ave # Chh16d, Portland, OR 97239-4501 | 2016-06-16 |
| 1033539184 | Natasha Fewkes Carter | Dermatology | 4914 Sw 1st Ave, Portland, OR 97239-2883 | 2014-04-16 |
| 1538588504 | Elizabeth Berry | Dermatology | Ohsu Department of Dermatology, 3303 Sw Bond Ave Ch 16d, Portland, OR 97239-4501 | 2014-04-07 |
| 1124250584 | Einar Axel Juhlin | Dermatology | 340 Eastern Promenade, Unit 154, Portland, ME 04101-2754 | 2009-08-19 |
| 1902040777 | Rajan P Kulkarni | Dermatology | 3303 Sw Bond Ave Ste 16, Portland, OR 97239 | 2009-04-23 |
| 1124280540 | Omar N Qutub | Dermatology | 1129 Nw 11th Ave, Portland, OR 97209-3469 | 2008-06-26 |
| 1285891168 | Stacy Nicole Reed | Dermatology | 13305 Nw Cornell Rd Ste C, Portland, OR 97229-5987 | 2008-05-19 |
| 1427243591 | Robert Bickford Amon | Dermatology | 1700 Sw Broadway Dr, Portland, OR 97201-2211 | 2007-09-11 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.