Provider Demographics
NPI:1700998226
Name:KALTENBAUGH, ORIE EUGENE (MD)
Entity Type:Individual
Prefix:MR
First Name:ORIE
Middle Name:EUGENE
Last Name:KALTENBAUGH
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 1:3565 QUAILRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-1785
Mailing Address - Country:US
Mailing Address - Phone:208-746-5132
Mailing Address - Fax:208-746-0087
Practice Address - Street 1:3565 QUAILRIDGE DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-1785
Practice Address - Country:US
Practice Address - Phone:208-746-5132
Practice Address - Fax:208-746-0087
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3226207X00000X
ND11290207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002642400Medicaid
ID1117077Medicare ID - Type Unspecified
0446840001Medicare NSC
ID002642400Medicaid