MEDICARE: CATHERINE MARIE ELLISON 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	2084N0400X	Neurology Physician	MD13535	OR

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831191535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE MARIE ELLISON MD

Provider Business Mailing Address
First Line	:	847 NE 19TH AVE
Second Line	:	SUITE 300
City	:	PORTLAND
State	:	OR
Zip	:	97232-2684
Country	:	US
Telephone Number	:	503-963-2801
Fax Number	:	503-963-2825

Provider Business Practice Location Address
First Line	:	1040 NW 22ND AVE
Second Line	:	SUITE 420
City	:	PORTLAND
State	:	OR
Zip	:	97210-3057
Country	:	US
Telephone Number	:	503-488-2424
Fax Number	:	503-229-7105

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	09/16/2013

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Directions to “ CATHERINE MARIE ELLISON MD” Practice Location

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