Healthcare Provider Details

I. General information

NPI: 1326112426
Provider Name (Legal Business Name): DOUGLAS DICHARRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12705 SE RIVER RD APT 105B
PORTLAND OR
97222-9735
US

IV. Provider business mailing address

12705 SE RIVER RD APT 105B
PORTLAND OR
97222-9735
US

V. Phone/Fax

Practice location:
  • Phone: 206-745-2741
  • Fax:
Mailing address:
  • Phone: 206-745-2741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD00028410
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: