Provider Demographics
NPI:1215922083
Name:VAJDOS, MARGARET A (MD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:VAJDOS
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 1229
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-1229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:503-907-9440
Practice Address - Street 1:1601 E 4TH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3753
Practice Address - Country:US
Practice Address - Phone:360-759-1901
Practice Address - Fax:360-905-1733
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19676207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORF83518Medicare UPIN
ORR114052Medicare PIN
ORF83518Medicare UPIN