Provider Demographics
NPI:1417909094
Name:NAIRN, ANGELA STOCK (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:STOCK
Last Name:NAIRN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:STOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2055 EXCHANGE ST
Mailing Address - Street 2:STE 190
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3419
Mailing Address - Country:US
Mailing Address - Phone:503-325-5300
Mailing Address - Fax:503-325-5400
Practice Address - Street 1:2055 EXCHANGE ST
Practice Address - Street 2:STE 190
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3419
Practice Address - Country:US
Practice Address - Phone:503-325-5300
Practice Address - Fax:503-325-5400
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288188Medicaid
OR110763Medicare ID - Type Unspecified
H15536Medicare UPIN