MEDICARE: DR. OLEG BALTER MD

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	207Q00000X	Family Medicine Physician	01072999A	IN
2	207Q00000X	Family Medicine Physician	MD222668	OR

General Provider Information

NPI Number	:	1770859878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLEG BALTER MD

Provider Business Mailing Address
First Line	:	1400 SW 5TH AVE STE 500
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97201-5537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10201 SE MAIN ST STE 10A
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97216-2968
Country	:	US
Telephone Number	:	503-255-2186
Fax Number	:	503-255-2194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	07/28/2025

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