Organization
OREGON PEDIATRICS- MERIDIAN PARK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RUPA KIRIT SHAH MD (OWNER / MEDICAL DIRECTOR)
(503) 659-1694
Entity
Organization
Contact information
Practice address
19250 SW 65TH AVE STE 100, TUALATIN, OR 97062-7707
(503) 691-2519
(503) 659-8984
Mailing address
19250 SW 65TH AVE STE 100, TUALATIN, OR 97062-7707
(503) 691-2519
(503) 659-8984
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022713
—
OR
Enumeration date
06/21/2006
Last updated
06/04/2020
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