Provider Demographics
NPI:1134341837
Name:MARLA KLEIN, MD LLC
Entity type:Organization
Organization Name:MARLA KLEIN, MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:INGRID
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-445-2200
Mailing Address - Street 1:5200 MEADOWS RD STE 250
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-0066
Mailing Address - Country:US
Mailing Address - Phone:503-445-2200
Mailing Address - Fax:503-445-2201
Practice Address - Street 1:5200 MEADOWS RD STE 250
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-0066
Practice Address - Country:US
Practice Address - Phone:503-445-2200
Practice Address - Fax:503-445-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG49986Medicare UPIN