Provider Demographics
NPI:1073870895
Name:CHIODO, MARCUS ALYN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:ALYN
Last Name:CHIODO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14947 SE ELM PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5501
Mailing Address - Country:US
Mailing Address - Phone:503-901-9321
Mailing Address - Fax:
Practice Address - Street 1:10000 SE MAIN ST STE 40
Practice Address - Street 2:ADVENTIST MEDICAL CENTER - THE PAVILION
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2461
Practice Address - Country:US
Practice Address - Phone:503-251-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR166715207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine