Provider Demographics
NPI:1245349190
Name:SCHWARZENBERGER, KATHRYN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:SCHWARZENBERGER
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:OREGON HEALTH AND SCIENCE UNIVERSITY
Mailing Address - Street 2:3181 SW SAM JACKSON PARK RD.
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-418-3376
Mailing Address - Fax:503-494-6844
Practice Address - Street 1:3303 SW BOND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-1375
Practice Address - Fax:503-418-1377
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000049928207N00000X
OR182101207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G07272Medicare UPIN