MARK S FETTMAN (NPI# 1043201981) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043201981 |
| Entity Type | Individual |
| Full Name | MARK S FETTMAN |
| Credential | MD |
| Practice Address |
9155 Sw Barnes Rd Ste 333 Portland OR 97225-6630 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5032165102 |
| Practice Fax Number | 5032162485 |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2020-10-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
MD175068 | OR | Allopathic & Osteopathic Physicians |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
35059345 | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500698053 | 05 |
| Street Address |
9155 SW BARNES RD STE 333 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97225-6630 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053968578 | Jennifer M Brinkman | Social Worker | 9155 Sw Barnes Rd Ste 333, Portland, OR 97225-6630 | 2019-08-20 |
| 1518476282 | Katrin E Beene | Clinical Neuropsychologist | 9155 Sw Barnes Rd Ste 333, Portland, OR 97225-6630 | 2017-09-26 |
| 1649684614 | Melanie Lynne Johnson | Counselor | 9155 Sw Barnes Rd Ste 333, Portland, OR 97225-6630 | 2014-06-17 |
| 1124380944 | Erika Siegel | Social Worker | 9155 Sw Barnes Rd Ste 333, Portland, OR 97225-6630 | 2012-06-08 |
| 1073659298 | Kendall M Johnson | Social Worker | 9155 Sw Barnes Rd Ste 333, Portland, OR 97225-6630 | 2007-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508425034 | Gabrielle Gonzales | Behavior Technician | 1675 Sw Marlow Ave, Suite 200, Portland, OR 97225 | 2019-06-08 |
| 1558844555 | Tate Roseberry | Behavior Technician | 1675 Sw Marlow Avenue, Suite 200, Portland, OR 97225 | 2018-09-14 |
| 1982186300 | Dean Alan Hopkins | Registered Nurse | 11782 Sw Barnes Rd, Suite 300, Portland, OR 97225 | 2018-09-01 |
| 1316449168 | Surgery Center At St. Vincent, LLC | Clinic/Center | 9135 Sw Barnes Rd Ste 161, Portland, OR 97225 | 2018-03-07 |
| 1730606716 | Meghan Louise Lacy | Pediatrics | 11790 Sw Barnes Rd, Blg. A, Suite 140, Portland, OR 97225 | 2017-08-29 |
| 1841733433 | Tia Pugh | Occupational Therapist | 9155 S.w. Barnes Road, East Pavilion, Portland, OR 97225 | 2016-11-30 |
| 1295185585 | Stephanie Lynn Hart | Nurse Practitioner | 9155 Sw Barnes Rd Ste 240, Portland, OR 97225 | 2016-06-16 |
| 1962866244 | Bejian Shamloo | Chiropractor | 10200 Sw Eastridge St., Suite 235, Portland, OR 97225 | 2016-04-12 |
| 1992162630 | Robert Joseph Yoder | Psychologist | 9045 Barnes Rd, Portland, OR 97225 | 2016-01-26 |
| 1316303951 | Katie Herold | Chiropractor | 9315 Sw Morrison St, Portland, OR 97225 | 2016-01-12 |
| Find all providers in zip 97225 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447878947 | Celia Mantovani | Psychiatry & Neurology | 15 Cypress St, Portland, ME 04103-2008 | 2020-07-10 |
| 1538782834 | Endeavor Psychiatry LLC | Psychiatry & Neurology | Sw, Portland, OR 97219-5885 | 2020-05-20 |
| 1154942142 | Prisma Wellness LLC | Psychiatry & Neurology | 10260 Sw Greenburg Rd Fl 4, Portland, OR 97223-5500 | 2020-04-30 |
| 1588291082 | Alexis Family Psychiatry, LLC | Psychiatry & Neurology | 415 Congress St Ste 202a, Portland, ME 04101-3500 | 2020-03-24 |
| 1881188084 | Geriatric Psychiatry Associates | Psychiatry & Neurology | 123 Nw 12th Ave Apt 424, Portland, OR 97209-4145 | 2018-06-20 |
| 1982104063 | Carl Chi | Psychiatry & Neurology | 22 Goodrich Ln, Portland, CT 06480-1063 | 2018-02-15 |
| 1154839108 | Cascade Tms LLC | Psychiatry & Neurology | 205 Se Spokane St Ste 301, Portland, OR 97202-6487 | 2018-01-11 |
| 1538601737 | Diana S Domnitei Md LLC | Psychiatry & Neurology | 1012 Sw King Ave Ste 306, Portland, OR 97205-1110 | 2016-11-06 |
| 1104286269 | Anne Fleming, Md, LLC | Psychiatry & Neurology | 2340 Nw Thurman St Ste 202, Portland, OR 97210-2579 | 2016-03-02 |
| 1417338708 | Andrew Justin Ruege | Psychiatry & Neurology | 5421 Sw Patton Rd, Portland, OR 97221-2226 | 2015-06-12 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.