Provider Demographics
NPI:1932312766
Name:OH, ANDREW H (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:H
Last Name:OH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 LIBERTY ST NE
Mailing Address - Street 2:STE 110
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-8381
Mailing Address - Country:US
Mailing Address - Phone:206-251-4040
Mailing Address - Fax:503-371-0805
Practice Address - Street 1:140 NW 14TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2601
Practice Address - Country:US
Practice Address - Phone:503-770-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60142376207L00000X, 207LP2900X
ORMD29175207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0264343OtherL & I
WA2004312Medicaid
WAG8893433Medicare PIN