Provider Demographics
NPI:1841348364
Name:KHADEM, MAY (MD)
Entity type:Individual
Prefix:DR
First Name:MAY
Middle Name:
Last Name:KHADEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MAY
Other - Middle Name:KHADEM
Other - Last Name:CZERNIEJEWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6420 S MACADAM AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3517
Mailing Address - Country:US
Mailing Address - Phone:503-244-8601
Mailing Address - Fax:503-244-3013
Practice Address - Street 1:2318 PORTLAND RD STE 300
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1374
Practice Address - Country:US
Practice Address - Phone:503-538-1341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061211207W00000X
ORMD180062207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500741673Medicaid