Healthcare Provider Details

I. General information

NPI: 1538426499
Provider Name (Legal Business Name): TODD B MACLEOD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 NE SANDY BLVD STE 1200
PORTLAND OR
97212-5336
US

IV. Provider business mailing address

4160 NE SANDY BLVD STE 1200
PORTLAND OR
97212-5336
US

V. Phone/Fax

Practice location:
  • Phone: 503-249-9000
  • Fax: 503-376-5341
Mailing address:
  • Phone: 503-249-9000
  • Fax: 503-376-5341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60763222
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006438
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA174736
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: