Provider Demographics
NPI:1780631655
Name:PITTA, SREEDEVI (MD)
Entity Type:Individual
Prefix:
First Name:SREEDEVI
Middle Name:
Last Name:PITTA
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 1:18610 NW CORNELL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9204
Practice Address - Country:US
Practice Address - Phone:503-216-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR026823Medicaid
ORP00451464OtherRR MEDICARE
ORP00451464OtherRR MEDICARE
ORI45768Medicare UPIN
ORR133257Medicare PIN