Provider Demographics
NPI:1275832073
Name:HEGEWALD, ALISHA MARIE HARRINGTON (DO, MACOM)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:MARIE HARRINGTON
Last Name:HEGEWALD
Suffix:
Gender:F
Credentials:DO, MACOM
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3600 NW SAMARITAN DR # D
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3600 NW SAMARITAN DR # D
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5472
Practice Address - Country:US
Practice Address - Phone:541-768-4906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC153161171100000X
ORPG215984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist