Provider Demographics
NPI:1629054085
Name:PETRE NEDITA, LUANA IONELA (MD)
Entity Type:Individual
Prefix:
First Name:LUANA
Middle Name:IONELA
Last Name:PETRE NEDITA
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:PO BOX 1700
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0414
Mailing Address - Country:US
Mailing Address - Phone:541-672-9515
Mailing Address - Fax:541-464-3177
Practice Address - Street 1:2460 NW STEWART PARKWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1516
Practice Address - Country:US
Practice Address - Phone:541-672-9515
Practice Address - Fax:541-464-3177
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24919207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274893Medicaid
OR274893Medicaid
I03193Medicare UPIN