Provider Demographics
NPI:1033135033
Name:WARE, MARSHA D (MD)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:D
Last Name:WARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:18610 NW CORNELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9204
Practice Address - Country:US
Practice Address - Phone:503-216-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR013784Medicaid
ORP00252356OtherRR MEDICARE
E57536Medicare UPIN
OR013784Medicaid
ORR153178Medicare PIN
ORP00252356OtherRR MEDICARE
ORR163849Medicare PIN
ORR163850Medicare PIN
ORR130375Medicare PIN