Provider Demographics
NPI:1851377931
Name:RACHITA, CORINA GABRIELA (MD)
Entity Type:Individual
Prefix:DR
First Name:CORINA
Middle Name:GABRIELA
Last Name:RACHITA
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 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:360-493-4069
Mailing Address - Fax:
Practice Address - Street 1:2395 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-5653
Practice Address - Country:US
Practice Address - Phone:541-957-5750
Practice Address - Fax:541-957-5766
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60107069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227244Medicaid
ORH88616Medicare UPIN
OR116330Medicare ID - Type Unspecified