Provider Demographics
NPI:1518923960
Name:BERI, MEENA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MEENA
Middle Name:
Last Name:BERI
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 1:5050 NE HOYT
Mailing Address - Street 2:#217
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213
Mailing Address - Country:US
Mailing Address - Phone:503-232-6104
Mailing Address - Fax:503-235-3753
Practice Address - Street 1:5050 NE HOYT
Practice Address - Street 2:#217
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213
Practice Address - Country:US
Practice Address - Phone:503-232-6104
Practice Address - Fax:503-235-3753
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17659207W00000X
WAMD00037978207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR271005Medicaid
OR271053Medicaid
OR271053Medicaid
WA8858844Medicare Oscar/Certification
OR271005Medicaid