Provider Demographics
NPI:1437186038
Name:MEGA, MICHAEL S (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:MEGA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 SW EASTRIDGE ST
Mailing Address - Street 2:STE 105
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5031
Mailing Address - Country:US
Mailing Address - Phone:503-207-2066
Mailing Address - Fax:503-548-4981
Practice Address - Street 1:10200 SW EASTRIDGE ST
Practice Address - Street 2:STE 105
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5031
Practice Address - Country:US
Practice Address - Phone:503-207-2066
Practice Address - Fax:503-548-4981
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD181852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR232463Medicaid
ORP00461865OtherRR MEDICARE
OR232463Medicaid
ORR139537Medicare PIN