Provider Demographics
NPI:1396824785
Name:MADARANG, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MADARANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 SW CEDAR HILLS BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1469
Mailing Address - Country:US
Mailing Address - Phone:916-536-3620
Mailing Address - Fax:916-536-3541
Practice Address - Street 1:6555 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0302
Practice Address - Country:US
Practice Address - Phone:916-536-3620
Practice Address - Fax:916-536-3541
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD184006207R00000X
CAA84980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A849800OtherBLUE SHIELD
CA90138934OtherPACIFICARE
CA000810587265OtherPHCS
CA7610562OtherFIRST HEALTH
CA00A849800Medicaid
CAMCMG297000OtherWESTERN HEALTH ADVANTAGE
CA2397651OtherUNITED HEALTHCARE
CA101971OtherINTERPLAN
CA104585OtherHEALTH NET
CA2165740OtherGREAT WEST
CA7721542OtherAETNA
CAA84980OtherBLUE CROSS
CA2397651OtherUNITED HEALTHCARE
CA00A849800Medicare ID - Type Unspecified