Provider Demographics
NPI:1366565509
Name:KAPADIA, AMI (MD)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:
Last Name:KAPADIA
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 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11719 NE 95TH ST STE A/D
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-2444
Practice Address - Country:US
Practice Address - Phone:360-397-8246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433101207Q00000X
WAMD.MD.61420145207Q00000X
ORMD 153491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500637214Medicaid
ORP00983321OtherRR MEDICARE - PH&S
NJ0171948Medicaid
PA1021982730001Medicaid
PA131585PAGMedicare PIN
ORR161148Medicare PIN
ORR161151Medicare PIN
ORR161149Medicare PIN
ORP00983321OtherRR MEDICARE - PH&S
PA1021982730001Medicaid
ORR161153Medicare PIN