Provider Demographics
NPI:1518041763
Name:OH, ELIZA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:
Last Name:OH
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 1:1733 S RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-8187
Mailing Address - Country:US
Mailing Address - Phone:503-409-9024
Mailing Address - Fax:503-212-0792
Practice Address - Street 1:1800 BLANKENSHIP RD
Practice Address - Street 2:STE 475
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4248
Practice Address - Country:US
Practice Address - Phone:503-344-6065
Practice Address - Fax:503-344-6065
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24754207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274876Medicaid
OR274876Medicaid
R117281Medicare ID - Type Unspecified