Provider Demographics
NPI:1790736536
Name:GILLESPIE, ANDREA HOOGERLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:HOOGERLAND
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:HOOGERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:595 NW SILVERADO DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6360
Mailing Address - Country:US
Mailing Address - Phone:503-577-9649
Mailing Address - Fax:
Practice Address - Street 1:2801 N GANTENBEIN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1623
Practice Address - Country:US
Practice Address - Phone:503-276-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN495382080P0203X
ORMD1578272080P0203X
WI44090208M00000X
OR1578272080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34464100Medicaid
008906261BOtherHUMANA
008906261BOtherHUMANA
I02122Medicare UPIN