Provider Demographics
NPI:1063466209
Name:NEWBERG RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:NEWBERG RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:DIRE
Authorized Official - Last Name:J
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-537-1578
Mailing Address - Street 1:PO BOX 6600
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-6600
Mailing Address - Country:US
Mailing Address - Phone:503-657-8663
Mailing Address - Fax:503-723-3180
Practice Address - Street 1:501 VILLA RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1832
Practice Address - Country:US
Practice Address - Phone:503-537-1578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR280321Medicaid
WA7001605Medicaid
OR0000WCGZJMedicare ID - Type Unspecified