DR. ALEXANDER DEMETRE NICOLOFF (NPI# 1386610277) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386610277 |
| Entity Type | Individual |
| Full Name | DR. ALEXANDER DEMETRE NICOLOFF |
| Credential | M.D. |
| Practice Address |
501 N Graham St Suite 415 Portland OR 97227-1654 |
| Practice Telephone | 5034133580 |
| Practice Fax Number | 5034133578 |
| Mailing Telephone | 5034133580 |
| Mailing Fax Number | 5034133578 |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2007-07-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
18926 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 226934 | 05 |
| Street Address |
501 N GRAHAM ST SUITE 415 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97227-1654 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508869157 | Paula Deanne Dietsch Kuiper | Physician Assistant | 501 N Graham St, Suite 220, Portland, OR 97227-1654 | 2005-05-27 |
| 1811454432 | Matthew James Luttrell | Registered Nurse | 501 N Graham St, Portland, OR 97227-1654 | 2019-03-01 |
| 1831640267 | Morgan Sue Huey | Physician Assistant | 501 N Graham St, Suite 415, Portland, OR 97227-1654 | 2016-10-20 |
| 1093169583 | Theresa Mcsherry | Nurse Practitioner | 501 N Graham St, Suite 555, Portland, OR 97227-1654 | 2016-04-20 |
| 1093172702 | Jeremy Alper | Pharmacist | 501 N Graham St, Portland, OR 97227-1654 | 2016-01-26 |
| 1003287269 | Evergreen Prosthetics and Orthotics, LLC | Durable Medical Equipment & Medical Supplies | 501 N Graham St, Ste 255, Portland, OR 97227-1654 | 2015-10-14 |
| 1316321110 | Portland Ear, Nose & Throat Specialists | Specialist | 501 N Graham St, Suite 455, Portland, OR 97227-1654 | 2015-07-13 |
| 1942693908 | Leigh Warsing | Physician Assistant | 501 N Graham St, Suite 580, Portland, OR 97227-1654 | 2015-03-13 |
| 1134521909 | Justin Hadaller | Physician Assistant | 501 N Graham St, Suite 580, Portland, OR 97227-1654 | 2014-09-23 |
| 1932542503 | Erica T Ballard | Physician Assistant | 501 N Graham St, Ste 200, Portland, OR 97227-1654 | 2013-04-12 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508466574 | Jessica Michelle Simonetti | Psychologist | Portland Psychotherapy Clinic, Research and Training Ce, 3700 N Williams Ave, Portland, OR 97227 | 2020-10-29 |
| 1447812268 | Maksim Yefimov | Physician Assistant | 2800 N Vancouver Ave Ste 130, Portland, OR 97227 | 2019-07-01 |
| 1851955975 | Erin Marie Staples | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave;, Suite 230, Portland, OR 97227 | 2019-04-24 |
| 1922588508 | Melanie Grace Mix | Physician Assistant | 501 N Graham St Ste 420, Portland, OR 97227 | 2018-08-14 |
| 1730615071 | Mehran Giblin | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave, Suite 230, Legacy Clinic Emanuel, Portland, OR 97227 | 2017-05-05 |
| 1730623687 | Christina Grace Belter | Optometrist | 300 N Graham St Ste 300, Portland, OR 97227 | 2016-12-12 |
| 1407300205 | Jenna Abernathy | Counselor | 3537 N Williams Ave, Portland, OR 97227 | 2016-08-09 |
| 1215390760 | Tanya Marie Woods | Massage Therapist | 3808 N. Williams Ave., Portland, OR 97227 | 2016-04-01 |
| 1033596853 | Eric Allen Martin | Counselor | 2054 N. Vancouver Ave, Portland, OR 97227 | 2015-04-30 |
| 1285040436 | Berk Neurosurgical LLC | Neurological Surgery | 501 N Graham St Ste 500, Portland, OR 97227 | 2014-07-09 |
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| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912334400 | Toshio Inahara | Surgery | 1115 Sw Summit View Dr, Portland, OR 97225-6197 | 2013-09-30 |
| 1902192396 | John Noel Dussel | Surgery | 9155 Sw Barnes Rd Ste 321, Portland, OR 97225 | 2011-06-23 |
| 1356584973 | Norina Mohd Nordin | Surgery | 9701 Sw Barnes Rd Ste 140, Portland, OR 97225-6688 | 2009-04-13 |
| 1669416244 | William C Duncan | Surgery | 5400 Sw Menefee Dr, Portland, OR 97239-2700 | 2006-06-15 |
| 1386640688 | Philip T Alexander | Surgery | 9701 Sw Barnes Rd, Ste 140, Portland, OR 97225 | 2005-06-22 |
| 1649658766 | Cherrie Abraham | Surgery | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2015-05-08 |
| 1811382773 | Vincent Noori | Surgery | 22 Bramhall St, Portland, ME 04102-3134 | 2015-03-30 |
| 1770921462 | Kimberly Taylor Malka | Surgery | 22 Bramhall St, Portland, ME 04102 | 2013-06-05 |
| 1134565492 | Anna Marie Boniakowski | Surgery | 887 Congress St Ste 400, Portland, ME 04102-3163 | 2013-05-14 |
| 1710253984 | Sheena Kim Harris | Surgery | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2012-03-31 |
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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.