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Individual

MARY ANNE JOSEPH NIDIRY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
5050 NE HOYT ST STE 540, PORTLAND, OR 97213-2985
(503) 216-6600
(503) 215-7751
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
242513
NY
207R00000X
Internal Medicine Physician
Primary
MD191875
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500759000
OR
Enumeration date
10/24/2006
Last updated
03/22/2021
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