Provider Demographics
NPI:1639160856
Name:BRODSKY, TRINA A (MD)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:A
Last Name:BRODSKY
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 1:7650 SW BEVELAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-855-1620
Mailing Address - Fax:503-840-3299
Practice Address - Street 1:7431 NW EVERGREEN PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5831
Practice Address - Country:US
Practice Address - Phone:503-734-3700
Practice Address - Fax:503-473-8462
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22493207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288410Medicaid
ORR107219OtherMEDICARE PTAN
OR288410Medicaid