Provider Demographics
NPI:1508061003
Name:LANNON, SOPHIA MARGARETA ROTHBERGER (MD)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MARGARETA ROTHBERGER
Last Name:LANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:MARGARETA
Other - Last Name:ROTHBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7650 SW BEVELAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-601-3615
Mailing Address - Fax:503-646-1683
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:SUITE 230
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2991
Practice Address - Country:US
Practice Address - Phone:503-482-1800
Practice Address - Fax:503-482-1805
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD171676207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0239220OtherL&I
ORR185240OtherMEDICARE PTAN
WA1508061003Medicaid
OR500668537Medicaid
WA1508061003Medicaid