Healthcare Provider Details

I. General information

NPI: 1962573725
Provider Name (Legal Business Name): CHRISTY ALANA MEADE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY A. MEADE M.D.

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N GANTENBEIN AVE
PORTLAND OR
97227-1623
US

IV. Provider business mailing address

101 SW MAIN ST STE 940
PORTLAND OR
97204-3216
US

V. Phone/Fax

Practice location:
  • Phone: 503-276-9191
  • Fax:
Mailing address:
  • Phone: 503-464-9034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA91449
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD0000043578
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: