Provider Demographics
NPI:1962573725
Name:MEADE, CHRISTY ALANA (MD)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:ALANA
Last Name:MEADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:A
Other - Last Name:MEADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 SW MAIN ST STE 940
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3216
Mailing Address - Country:US
Mailing Address - Phone:503-464-9034
Mailing Address - Fax:
Practice Address - Street 1:2801 N GANTENBEIN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1623
Practice Address - Country:US
Practice Address - Phone:503-276-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91449208000000X
TNMD00000435782080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A914490Medicaid
CA00A914490Medicaid
CAI49407Medicare UPIN