MEDICARE: OREGON PEDIATRICS- MERIDIAN PARK, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659317386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OREGON PEDIATRICS- MERIDIAN PARK, LLC

Provider Business Mailing Address
First Line	:	19250 SW 65TH AVE STE 100
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-7707
Country	:	US
Telephone Number	:	503-691-2519
Fax Number	:	503-659-8984

Provider Business Practice Location Address
First Line	:	19250 SW 65TH AVE STE 100
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-7707
Country	:	US
Telephone Number	:	503-691-2519
Fax Number	:	503-659-8984

Authorized Official
Title or Position	:	OWNER / MEDICAL DIRECTOR
Name	:	MRS. RUPA KIRIT SHAH
Credential	:	MD
Telephone Number	:	503-659-1694

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	06/04/2020

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Directions to “OREGON PEDIATRICS- MERIDIAN PARK, LLC ” Practice Location

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