DR. MARK DAVID TILSON (NPI# 1134345523) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134345523 |
| Entity Type | Individual |
| Full Name | DR. MARK DAVID TILSON |
| Credential | PH.D. |
| Practice Address |
1015 Nw 22nd Ave Rio - 5 East Portland OR 97210-3025 |
| Practice Telephone | 5034137662 |
| Practice Fax Number | 5034138103 |
| Mailing Telephone | 5034137662 |
| Mailing Fax Number | 5034138103 |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 103G00000X | Clinical Neuropsychologist | 826 | OR | Behavioral Health & Social Service Providers |
| X | 103TC0700X |
Psychologist Specialization: Clinical |
826 | OR | Behavioral Health & Social Service Providers |
| X | 103TR0400X |
Psychologist Specialization: Rehabilitation |
826 | OR | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 079009 | 05 |
| Street Address |
1015 NW 22ND AVE RIO - 5 EAST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97210-3025 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467449629 | Chen-wen Christopher Heh | Psychiatry & Neurology | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2005-10-03 |
| 1023620770 | Jenelle Lynn Stinson | Pharmacist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2020-08-22 |
| 1821618935 | Jena Jobin | Pharmacist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2020-04-17 |
| 1164041810 | Danielle Amelie Parker | Occupational Therapist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2020-04-13 |
| 1659910362 | Ellen Lee | Nurse Anesthetist, Certified Registered | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2019-12-27 |
| 1487291787 | Nicholai Leon Mathewson | Nurse Anesthetist, Certified Registered | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2019-12-05 |
| 1528603438 | Lap Huy Nguyen | Pharmacist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2019-11-14 |
| 1649814617 | Ethan Andrew Blashford | Pharmacist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2019-11-03 |
| 1770127854 | Meri Leah Grotzinger | Pharmacist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2019-11-01 |
| 1467095307 | Dennis Thompson | Pharmacist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2019-10-23 |
| 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 | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801098090 | Nancy Loss | Clinical Neuropsychologist | 2223 Ne 47th Avenue, Portland, OR 97213 | 2007-06-01 |
| 1346457017 | Mark Gregory Kiefner | Clinical Neuropsychologist | 26 Portland Street, Portland, ME 04101 | 2007-05-16 |
| 1184774937 | Melvyn E Attfield | Clinical Neuropsychologist | 225 Commercial Street, Suite #303, Portland, ME 04101 | 2007-01-12 |
| 1437215712 | Patrice Deidre Carrello | Clinical Neuropsychologist | 2354 Se 59th Ave, Portland, OR 97215-4018 | 2006-12-29 |
| 1386722247 | Donald Edward Lange | Clinical Neuropsychologist | 8040 Sw Capitol Hill Rd, Portland, OR 97219-2670 | 2006-11-01 |
| 1497831713 | James (jim) Charles Johnson | Clinical Neuropsychologist | 516 Se 71st Ave, Portland, OR 97215-2132 | 2006-10-29 |
| 1245327501 | Julia Ann Wong-ngan | Clinical Neuropsychologist | 205 Se Spokane St Ste 300, Portland, OR 97202-6487 | 2006-10-06 |
| 1295820389 | Nadia E. Webb | Clinical Neuropsychologist | 1631 Ne Broadway Street. No. 237, Portland, OR 97232 | 2006-10-04 |
| 1720094477 | Thomas G Miller | Clinical Neuropsychologist | 86 Dartmouth St, Portland, ME 04103-4808 | 2006-08-01 |
| 1811923246 | Dawn Wilkinson | Clinical Neuropsychologist | 458 N Broadway, Suite B, Portland, TN 37148-1767 | 2006-06-25 |
| Find all providers in PORTLAND | ||||
Please comment or provide details below to improve the information on DR. MARK DAVID TILSON.
| 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.