Provider Demographics
NPI:1750475356
Name:MARCUS, ELAINE R (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:R
Last Name:MARCUS
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:503-215-6494
Mailing Address - Fax:
Practice Address - Street 1:1321 NE 99TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9437
Practice Address - Country:US
Practice Address - Phone:503-215-9900
Practice Address - Fax:503-215-4055
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00729898OtherRR MEDICARE
OR279160Medicaid
ORR141197Medicare PIN
E32680Medicare UPIN
ORR160870Medicare PIN
ORR161985Medicare PIN
OR279160Medicaid
WAG8903699Medicare PIN
ORP00729898OtherRR MEDICARE
ORR152703Medicare PIN