Provider Demographics
NPI:1457357576
Name:RYDZIK, BEATA L (MD)
Entity Type:Individual
Prefix:
First Name:BEATA
Middle Name:L
Last Name:RYDZIK
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 1:9427 SW BARNES RD
Mailing Address - Street 2:SUITE 495
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6652
Mailing Address - Country:US
Mailing Address - Phone:503-297-3440
Mailing Address - Fax:503-297-4584
Practice Address - Street 1:9427 SW BARNES RD
Practice Address - Street 2:SUITE 495
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6652
Practice Address - Country:US
Practice Address - Phone:503-297-3440
Practice Address - Fax:503-297-4584
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25039207N00000X, 207NI0002X, 207NS0135X, 207ND0900X
WAMD00043352207N00000X, 207NI0002X, 207NS0135X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR234458Medicaid
ORR142464Medicare PIN
I11744Medicare UPIN
OR234458Medicaid