Provider Demographics
NPI:1699090092
Name:RITER, MELINDA CUSHING (MD, PHD)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:CUSHING
Last Name:RITER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:C
Other - Last Name:CUSHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3303 SW BOND AVE # 16D
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-494-3376
Mailing Address - Fax:
Practice Address - Street 1:3303 SW BOND AVE # 16D
Practice Address - Street 2:OHSU
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-418-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR390200000X
ORMD151435207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1699090092Medicaid
OR1699090092Medicaid