Provider Demographics
NPI:1477616845
Name:SABIN, CHARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:
Last Name:SABIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PMB 753
Mailing Address - Street 2:4110 SE HAWTHORNE BLVD.
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5246
Mailing Address - Country:US
Mailing Address - Phone:503-282-6473
Mailing Address - Fax:503-282-6473
Practice Address - Street 1:106 SW WOODS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4739
Practice Address - Country:US
Practice Address - Phone:503-282-6448
Practice Address - Fax:503-282-6473
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD113032080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR285080Medicaid
ORC92030Medicare UPIN