Provider Demographics
NPI:1639110166
Name:REMINGTON, GINA P (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:P
Last Name:REMINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E ELLENDALE AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-3052
Mailing Address - Country:US
Mailing Address - Phone:503-623-8151
Mailing Address - Fax:503-623-8185
Practice Address - Street 1:410 E ELLENDALE AVE
Practice Address - Street 2:STE 2
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-3052
Practice Address - Country:US
Practice Address - Phone:503-623-8151
Practice Address - Fax:503-623-8185
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD25243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR271140Medicaid
ORH63458Medicare UPIN
OR271140Medicaid