Provider Demographics
NPI:1790211845
Name:DANFORTH, OLIVIA MARTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:MARTINE
Last Name:DANFORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:MARTIN
Other - Last Name:DANFORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1188
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 GEARY ST SE STE 200
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-6842
Practice Address - Country:US
Practice Address - Phone:541-768-5418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPG183394207Q00000X
ORMD194957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine