Provider Demographics
NPI:1124166590
Name:MILES, CATHERINE MARY (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARY
Last Name:MILES
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:PO BOX 4207
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4207
Mailing Address - Country:US
Mailing Address - Phone:503-268-4802
Mailing Address - Fax:503-268-4801
Practice Address - Street 1:2801 N GANTENBEIN AVE
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1623
Practice Address - Country:US
Practice Address - Phone:503-413-2892
Practice Address - Fax:503-413-2982
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15746207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8429052Medicaid
OR931071318OtherTAX ID
OR041918Medicaid
OR931071318OtherTAX ID
ORF51481Medicare UPIN
OR041918Medicaid
WA8429052Medicaid