Provider Demographics
NPI:1619187143
Name:CRITTENDEN, MARKA RAE (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MARKA
Middle Name:RAE
Last Name:CRITTENDEN
Suffix:
Gender:F
Credentials:MD PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:541 NE 20TH AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2895
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:4805 NE GLISAN ST
Practice Address - Street 2:GARDEN LEVEL
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:503-215-6029
Practice Address - Fax:503-215-6387
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD1501512085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8558553Medicaid
OR500610535Medicaid
OR149948Medicare PIN