Provider Demographics
NPI:1427088368
Name:MORELAND, NANCY KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:KATHRYN
Last Name:MORELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:MORELAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:17727 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-4803
Mailing Address - Country:US
Mailing Address - Phone:503-215-9800
Mailing Address - Fax:503-215-9841
Practice Address - Street 1:1321 NE 99TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9436
Practice Address - Country:US
Practice Address - Phone:503-215-9900
Practice Address - Fax:503-215-4055
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00251738OtherRR MEDICARE
B77176Medicare UPIN