Healthcare Provider Details

I. General information

NPI: 1215922083
Provider Name (Legal Business Name): MARGARET A VAJDOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 4TH PLAIN BLVD
VANCOUVER WA
98661-3753
US

IV. Provider business mailing address

PO BOX 1229
FAIRVIEW OR
97024-1229
US

V. Phone/Fax

Practice location:
  • Phone: 360-759-1901
  • Fax: 360-905-1733
Mailing address:
  • Phone:
  • Fax: 503-907-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number19676
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: