Provider Demographics
NPI:1144089830
Name:MAKARIDZE, MAKHAMMAD
Entity type:Individual
Prefix:MR
First Name:MAKHAMMAD
Middle Name:
Last Name:MAKARIDZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16887 SW SNOWDALE ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-2019
Mailing Address - Country:US
Mailing Address - Phone:971-268-1900
Mailing Address - Fax:
Practice Address - Street 1:16887 SW SNOWDALE ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-2019
Practice Address - Country:US
Practice Address - Phone:971-268-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA225005172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty