OrganizationActive
Evgeny I Fedotov
NPI 1962412510 · Clinical Medical Laboratory · Portland, OR
Provider details
- NPI number
- 1962412510
- Entity type
- Organization
- Primary specialty
- Clinical Medical LaboratoryLaboratories
- Organization subpart
- No
- Authorized official
- Evgeny Fedotov, President(503) 252-5042
Specialties & taxonomies
Laboratories
Practice location
6629 Ne 82nd Ave
Suite 203
Portland, OR 97220-1346
Phone: (503) 756-8159
Approximate (ZIP-level) locationGet directions
Mailing address
6629 Ne 82nd Ave
Portland, OR 97220-1346
Other names (DBA / former)
- Doing business as
- North West Clinical Laboratory
Registry dates
- Enumerated
- 2006-08-08
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.