Provider Demographics
NPI:1205938784
Name:SYTSMA, VIRGINIA M (MD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:M
Last Name:SYTSMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:M
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2701 NW VAUGHN ST STE 140
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-5344
Mailing Address - Country:US
Mailing Address - Phone:503-499-5200
Mailing Address - Fax:
Practice Address - Street 1:2701 NW VAUGHN ST
Practice Address - Street 2:SUITE 160
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5311
Practice Address - Country:US
Practice Address - Phone:503-721-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18021207R00000X
WA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine