Provider Demographics
NPI:1558325175
Name:PARKER, MELANIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:A
Last Name:PARKER
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 1:6312 SW CAPITOL HWY # 502
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1938
Mailing Address - Country:US
Mailing Address - Phone:503-464-9034
Mailing Address - Fax:
Practice Address - Street 1:6312 SW CAPITOL HWY # 502
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-1938
Practice Address - Country:US
Practice Address - Phone:503-464-9034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24755207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8390189Medicaid
202433OtherWASHINGTON L&I
P00232005OtherRAILROAD MEDICARE
OR275091Medicaid
P00232005OtherRAILROAD MEDICARE
OR275091Medicaid