Provider Demographics
NPI:1962578104
Name:CAVANAUGH, MEGAN M (MD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:CAVANAUGH
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 1:9155 SW BARNES RD
Mailing Address - Street 2:SUITE 231
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6625
Mailing Address - Country:US
Mailing Address - Phone:971-254-9884
Mailing Address - Fax:503-206-8365
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:SUITE 231
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-216-5380
Practice Address - Fax:503-216-5399
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25132208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022760Medicaid
119457Medicare ID - Type Unspecified
OR022760Medicaid