Provider Demographics
NPI:1154527042
Name:CARNEY, STACIE LORRAINE (MD)
Entity type:Individual
Prefix:DR
First Name:STACIE
Middle Name:LORRAINE
Last Name:CARNEY
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 1:7320 SW HUNZIKER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2302
Mailing Address - Country:US
Mailing Address - Phone:503-941-3077
Mailing Address - Fax:503-747-7013
Practice Address - Street 1:10330 SE 32ND AVE STE 325
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6656
Practice Address - Country:US
Practice Address - Phone:503-416-1960
Practice Address - Fax:503-416-1959
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR279260Medicaid
OR279260Medicaid
CA00A936720Medicaid