Provider Demographics
NPI:1184849762
Name:BRANCATO, SCOTT C (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:BRANCATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 NE 20TH AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2895
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:19260 SW 65TH AVE STE 420
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-5712
Practice Address - Country:US
Practice Address - Phone:503-692-0405
Practice Address - Fax:503-692-7978
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13036207RC0000X
MA246917207RC0000X
ORMD159484207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021388Medicaid
OR500646436Medicaid
ORP01131271OtherRR MEDICARE (PH&S)
R167375Medicare PIN
OR500646436Medicaid
R165616Medicare PIN