Provider Demographics
NPI:1760776041
Name:KIELY, MARIA XIMENA TRAA (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:XIMENA TRAA
Last Name:KIELY
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:XIMENA
Other - Last Name:TRAA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:541 NE 20TH AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2895
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:4805 NE GLISAN ST STE 6N60
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213
Practice Address - Country:US
Practice Address - Phone:503-281-0561
Practice Address - Fax:503-416-7377
Is Sole Proprietor?:No
Enumeration Date:2011-06-05
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248886208600000X
ORMD188947208C00000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500729766Medicaid