Provider Demographics
NPI:1164969150
Name:MAGID-VOLK, PATRICIA SUZANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:SUZANNE
Last Name:MAGID-VOLK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3842 SW NEVADA CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1513
Mailing Address - Country:US
Mailing Address - Phone:503-577-7793
Mailing Address - Fax:
Practice Address - Street 1:3842 SW NEVADA CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1513
Practice Address - Country:US
Practice Address - Phone:503-577-7793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04254172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker