Provider Demographics
NPI:1083012108
Name:MARCIA KERENSKY, MD
Entity Type:Organization
Organization Name:MARCIA KERENSKY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:KERENSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-715-6437
Mailing Address - Street 1:1804 SW PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2050
Mailing Address - Country:US
Mailing Address - Phone:503-715-6437
Mailing Address - Fax:
Practice Address - Street 1:1804 SW PENDLETON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2050
Practice Address - Country:US
Practice Address - Phone:503-715-6437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-06
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16947311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OREO1902Medicare UPIN