Provider Demographics
NPI:1609824754
Name:ERDE, KAREN M (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:ERDE
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 1:9000 N LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-3006
Mailing Address - Country:US
Mailing Address - Phone:503-988-3663
Mailing Address - Fax:503-988-5305
Practice Address - Street 1:9000 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-3006
Practice Address - Country:US
Practice Address - Phone:503-988-3663
Practice Address - Fax:503-988-5305
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276313Medicaid
C92589Medicare UPIN
ORR145813Medicare PIN