Provider Demographics
NPI:1770588949
Name:SKARADA, DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:SKARADA
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 1:340 VISTA AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4546
Mailing Address - Country:US
Mailing Address - Phone:503-584-1174
Mailing Address - Fax:503-399-1229
Practice Address - Street 1:340 VISTA AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4546
Practice Address - Country:US
Practice Address - Phone:503-584-1174
Practice Address - Fax:503-584-1330
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23186207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287190Medicaid
OR287190Medicaid
ORH04757Medicare UPIN