Provider Demographics
NPI:1609944149
Name:PINKERT, TED CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:CHARLES
Last Name:PINKERT
Suffix:
Gender:M
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:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-0310
Mailing Address - Country:US
Mailing Address - Phone:503-681-1145
Mailing Address - Fax:
Practice Address - Street 1:335 SE 8TH AVE
Practice Address - Street 2:TUALITY COMMUNITY HOSPITAL
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4248
Practice Address - Country:US
Practice Address - Phone:503-681-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09508207U00000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR160069Medicaid
ORR00WCPFVAMedicare PIN
D86799Medicare UPIN
OR220007634Medicare PIN