Provider Demographics
NPI:1770741852
Name:KARLEEN SWARZTRAUBER
Entity type:Organization
Organization Name:KARLEEN SWARZTRAUBER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARZTRAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-675-6776
Mailing Address - Street 1:PO BOX 19266
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97280-0266
Mailing Address - Country:US
Mailing Address - Phone:503-675-6776
Mailing Address - Fax:
Practice Address - Street 1:506 VILLA RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1833
Practice Address - Country:US
Practice Address - Phone:503-538-4544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KARLEEN SWARZTRAUBER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMD227242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR121933Medicare PIN