Provider Demographics
NPI:1417068198
Name:MACASA, ANN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:MACASA
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 1:402 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1831
Mailing Address - Country:US
Mailing Address - Phone:503-538-7500
Mailing Address - Fax:503-538-9183
Practice Address - Street 1:402 VILLA RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1831
Practice Address - Country:US
Practice Address - Phone:503-538-7500
Practice Address - Fax:503-538-9183
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26899207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR247403Medicaid
OR247403Medicaid