Provider Demographics
NPI:1306966569
Name:COLUMBIA MEDICAL AND ENDOCRINE CLINIC
Entity type:Organization
Organization Name:COLUMBIA MEDICAL AND ENDOCRINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAJDOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-667-8400
Mailing Address - Street 1:501 NE HOOD AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7303
Mailing Address - Country:US
Mailing Address - Phone:503-667-8400
Mailing Address - Fax:503-907-7072
Practice Address - Street 1:501 NE HOOD AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7303
Practice Address - Country:US
Practice Address - Phone:503-667-8400
Practice Address - Fax:503-907-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19676207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR079874Medicaid
OR079874Medicaid
ORR114052Medicare ID - Type Unspecified