Provider Demographics
NPI:1801878996
Name:HAUPTMANN, MARY CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CHRISTINE
Last Name:HAUPTMANN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11086 SE OAK ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6692
Mailing Address - Country:US
Mailing Address - Phone:503-557-2020
Mailing Address - Fax:503-344-5110
Practice Address - Street 1:10819 SE STARK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3161
Practice Address - Country:US
Practice Address - Phone:503-255-2291
Practice Address - Fax:503-252-1797
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2009-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD13142207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR138974Medicaid
C90978Medicare UPIN
OR138974Medicaid