MEDICARE: DR. DORIN MEREDITH KEMMERLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD22473	OR

General Provider Information

NPI Number	:	1700813854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DORIN MEREDITH KEMMERLE MD

Provider Business Mailing Address
First Line	:	4350 COMMERCIAL ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-3914
Country	:	US
Telephone Number	:	503-877-4485
Fax Number	:	888-977-1263

Provider Business Practice Location Address
First Line	:	4350 COMMERCIAL ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-3914
Country	:	US
Telephone Number	:	503-877-4485
Fax Number	:	888-977-1263

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	12/12/2016

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