Provider Demographics
NPI:1215536560
Name:MCGAUGHEY, IRINA A (LE)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:A
Last Name:MCGAUGHEY
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 SW ALDER ST STE 920
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3610
Mailing Address - Country:US
Mailing Address - Phone:503-227-6050
Mailing Address - Fax:503-227-6050
Practice Address - Street 1:610 SW ALDER ST STE 920
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3610
Practice Address - Country:US
Practice Address - Phone:503-227-6050
Practice Address - Fax:503-227-6050
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-E-10160251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORBAP-E-10160251OtherELECTROLOGIST LICENSING