Provider Demographics
NPI:1891943221
Name:QUADE, SAMANTHA JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JANE
Last Name:QUADE
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:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:3216 NORTON AVE
Practice Address - Street 2:STE 202
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4290
Practice Address - Country:US
Practice Address - Phone:425-297-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60020807208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8940447Medicare UPIN