Provider Demographics
NPI:1891024907
Name:OLSON, MARY MAHER (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MAHER
Last Name:OLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MAHER
Other - Last Name:NAWAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11790 SW BARNES RD., BLDG. A., STE. 140
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225
Mailing Address - Country:US
Mailing Address - Phone:503-579-3214
Mailing Address - Fax:503-579-2027
Practice Address - Street 1:12442 SW SCHOLLS FERRY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-3396
Practice Address - Country:US
Practice Address - Phone:503-579-3214
Practice Address - Fax:503-579-2027
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO150422208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics