Provider Demographics
NPI:1851402481
Name:OELLRICH, CHERI N (MD)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:N
Last Name:OELLRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHERI
Other - Middle Name:N
Other - Last Name:KLAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 92900
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:417 SE 164TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-8943
Practice Address - Country:US
Practice Address - Phone:360-896-6944
Practice Address - Fax:360-254-2894
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045697207Q00000X
ORMD26969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213200Medicaid
0213009OtherWA L&I
WA8462764Medicaid
WA8861904Medicare PIN
WA8462764Medicaid