Provider Demographics
NPI:1194774208
Name:ANSLINGER, MAILE (MD)
Entity type:Individual
Prefix:
First Name:MAILE
Middle Name:
Last Name:ANSLINGER
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 1520
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058
Mailing Address - Country:US
Mailing Address - Phone:541-506-6920
Mailing Address - Fax:541-296-5451
Practice Address - Street 1:551 LONE PINE BLVD
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1520
Practice Address - Country:US
Practice Address - Phone:541-506-6920
Practice Address - Fax:541-296-5451
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8357207R00000X
ORMD27642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218103Medicaid
ID806955000Medicaid
I21253Medicare UPIN
ID806955000Medicaid
OR383994Medicare Oscar/Certification
R147467Medicare PIN