Provider Demographics
NPI:1609972215
Name:LANDERS, MAERAN (MD)
Entity Type:Individual
Prefix:
First Name:MAERAN
Middle Name:
Last Name:LANDERS
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 1:19255 SW 65TH AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7451
Mailing Address - Country:US
Mailing Address - Phone:503-692-9525
Mailing Address - Fax:503-692-8643
Practice Address - Street 1:19255 SW 65TH AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7451
Practice Address - Country:US
Practice Address - Phone:503-692-9525
Practice Address - Fax:503-692-8643
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24862207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology