Provider Demographics
NPI:1205853256
Name:DR. PAULA D KILPATRICK
Entity Type:Organization
Organization Name:DR. PAULA D KILPATRICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KILPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-697-3001
Mailing Address - Street 1:4035 MERCANTILE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2546
Mailing Address - Country:US
Mailing Address - Phone:503-697-3001
Mailing Address - Fax:503-697-0906
Practice Address - Street 1:4035 MERCANTILE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2546
Practice Address - Country:US
Practice Address - Phone:503-697-3001
Practice Address - Fax:503-697-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134179872OtherINDIVIDUAL NPI#
1134179872OtherINDIVIDUAL NPI#