Provider Demographics
NPI:1700855517
Name:CARISIO FARBER, RENEE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:CARISIO FARBER
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 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4805 NE GLISAN ST
Practice Address - Street 2:UNIT 3K
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:503-215-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232018207V00000X
ORMD169393207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500678128Medicaid
ORR179367Medicare PIN
H75576Medicare UPIN
ORR179366Medicare PIN
ORR177556Medicare PIN
ORR173728Medicare PIN
VA460786OtherANTHEM BS
56260OtherCOMMUNITY HEALTH SENTARA
286864OtherAMERIGROUP
MDF9350001OtherCARE FIRST
286864OtherMAMSI HEALTH PLANS
H75576Medicare UPIN
0007684371OtherAETNA PPO
286864OtherMDIPA OPTIMUM CHOICE
6216811OtherVIRGINIA PREMIER
VA006216811Medicaid