FAWN MELANIE WOLF (NPI# 1689636557) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689636557 |
| Entity Type | Individual |
| Full Name | FAWN MELANIE WOLF |
| Other Name | FAWN MELANIE JUVINALL |
| Credential | M.D. |
| Practice Address |
9155 Sw Bernes Rd. Suite 638 Portland OR 97225 |
| Practice Telephone | 5032167000 |
| Practice Fax Number | 5032166940 |
| Mailing Telephone | 5032167000 |
| Mailing Fax Number | 5032166940 |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2019-01-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | MD25195 | OR | Allopathic & Osteopathic Physicians |
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
MD25195 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 277859 | 05 |
| Street Address |
9155 SW BERNES RD. SUITE 638 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97225 |
| 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 | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669731204 | Elena Vladimirovna Varlamov | Internal Medicine | 3181 Sw Sam Jackson Park Road, L607, Portland, OR 97239-3098 | 2012-05-15 |
| 1134486780 | Leah M Wilson | Internal Medicine | 3181 Sw Sam Jackson Park Rd L579, Ohsu, Portland, OR 97239 | 2012-04-20 |
| 1700983574 | Maria Fleseriu | Internal Medicine | 3181 Sw Sam Jackson Park Rd # Bte472, Portland, OR 97239-3011 | 2006-09-20 |
| 1437138955 | Wesley P Fairfield | Internal Medicine | 144 State St Fl 4, Portland, ME 04101-3776 | 2006-01-12 |
| 1811985963 | David Rawson Hotelling | Internal Medicine | 477 Congress St, 5th Floor, Portland, ME 04101-3427 | 2005-10-12 |
| 1942795539 | Teresa Anne Hillier Graham | Internal Medicine | 3800 N Interstate Ave, Portland, OR 97227-1110 | 2018-06-26 |
| 1982067351 | Shao Ting Dawn Lim | Internal Medicine | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2016-04-01 |
| 1497044614 | Sarah Soltman | Internal Medicine | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2011-03-29 |
| 1871892653 | Sarah Hopkins | Internal Medicine | 5050 Ne Hoyt St, Suite 540, Portland, OR 97213-2991 | 2011-03-20 |
| 1699076133 | Mainehealth | Internal Medicine | 22 Bramhall St, Portland, ME 04102 | 2010-11-16 |
| 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.