Provider Demographics
NPI:1407967912
Name:WONG, TRISHA E (MD)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:E
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SAM JACKSON PARK ROAD
Mailing Address - Street 2:OHSU, PEDIATRIC HEM/ONC CDRCP
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-494-0829
Mailing Address - Fax:
Practice Address - Street 1:3181 SAM JACKSON PARK ROAD
Practice Address - Street 2:OHSU, PEDIATRIC HEM/ONC CDRCP
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-0829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000467362080P0207X
ORMD1261052080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology