Provider Demographics
NPI:1912990664
Name:KLEIN, MARLA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:MARIE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 MEADOWS RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3202
Mailing Address - Country:US
Mailing Address - Phone:503-445-2200
Mailing Address - Fax:503-445-2201
Practice Address - Street 1:5200 MEADOWS RD
Practice Address - Street 2:STE 250
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3202
Practice Address - Country:US
Practice Address - Phone:503-445-2200
Practice Address - Fax:503-445-2201
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG49986Medicare UPIN