Provider Demographics
NPI:1982667630
Name:FOLEY, MATTHEW I (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:I
Last Name:FOLEY
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 1:2962 SW CHAMPLAIN DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-5875
Mailing Address - Country:US
Mailing Address - Phone:503-327-8272
Mailing Address - Fax:
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-413-7557
Practice Address - Fax:503-413-6547
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD214152086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227291Medicaid
H86556Medicare UPIN
OR131465Medicare ID - Type Unspecified