Provider Demographics
NPI:1780722611
Name:RADER, ANNE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:ELIZABETH
Last Name:RADER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2801 N GANTENBEIN AVE
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1623
Mailing Address - Country:US
Mailing Address - Phone:503-413-4737
Mailing Address - Fax:503-413-2982
Practice Address - Street 1:2801 N GANTENBEIN AVE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1623
Practice Address - Country:US
Practice Address - Phone:503-268-4802
Practice Address - Fax:503-268-4801
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21216207ZP0102X
WAMD00044850207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151189OtherOR WELFARE
OR151189Medicaid
OR151189Medicaid
ORP00272958Medicare PIN
OR151189OtherOR WELFARE
ORR131375Medicare PIN