Healthcare Provider Details

I. General information

NPI: 1831922418
Provider Name (Legal Business Name): ANNA SKOSIREVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10315 NE TANASBOURNE DR
HILLSBORO OR
97124-7836
US

IV. Provider business mailing address

222 KINGS WAY
CLEMSON SC
29631-2112
US

V. Phone/Fax

Practice location:
  • Phone: 503-249-3434
  • Fax:
Mailing address:
  • Phone: 613-501-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.MD.61579568
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD221397
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: