Provider Demographics
NPI:1720011521
Name:NOBLE, SUSAN CARLA DAHLBERG (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CARLA DAHLBERG
Last Name:NOBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:CARLA
Other - Last Name:DAHLBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1015 NW 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3025
Mailing Address - Country:US
Mailing Address - Phone:503-413-8407
Mailing Address - Fax:
Practice Address - Street 1:437 NW WA NA PA ST
Practice Address - Street 2:
Practice Address - City:CASCADE LOCKS
Practice Address - State:OR
Practice Address - Zip Code:97014-7014
Practice Address - Country:US
Practice Address - Phone:503-740-9812
Practice Address - Fax:503-740-9812
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44114207L00000X
ORMD15783207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269865Medicaid
CAHSP40248FMedicaid
WA8468910Medicaid
WA8468910Medicaid
OR139725Medicare PIN
CA94-6000524OtherCOUNTY OF MONTEREY EIN
WA8468910Medicaid