Active NPI
Advanced Dermatology of Oregon PC
- Dermatology Physician
- Tualatin, OR
National Provider Identifier
1215035332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 338484-90
- Legal business name
- ADVANCED DERMATOLOGY OF OREGON PC
- Practice address
- 19255 SW 65TH Ave
Ste 260
Tualatin, OR 97062-7451 - Phone
- (503) 692-9525
- Fax
- (503) 692-8643
- NPI assigned
- Sep 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Maeran Landers, M.D.
- Title
- Owner
- Phone
- (503) 692-9525
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 338484-90 | OR | Primary |
Addresses
Primary practice location
19255 SW 65TH Ave
Ste 260
Tualatin, OR 97062-7451
Mailing address
19255 SW 65TH Ave
Ste 260
Tualatin, OR 97062-7451
Phone (503) 692-9525
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
19260 SW 65th Ave
Ste 270
Tualatin, OR 97062
Phone (503) 692-9525
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Dermatology Physician
- Tualatin, OR
- NPI 1609972215
-
- Medical Physician Assistant
- Tualatin, OR
- NPI 1750703450
-
- Physician Assistant
- Tualatin, OR
- NPI 1679347843
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1409097600000",
"number": "1215035332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19255 SW 65TH AVE",
"address_2": "STE 260",
"city": "TUALATIN",
"state": "OR",
"postal_code": "970627451",
"telephone_number": "503-692-9525",
"fax_number": "503-692-8643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19255 SW 65TH AVE",
"address_2": "STE 260",
"city": "TUALATIN",
"state": "OR",
"postal_code": "970627451",
"telephone_number": "503-692-9525",
"fax_number": "503-692-8643"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADVANCED DERMATOLOGY OF OREGON PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-20",
"last_updated": "2014-08-27",
"status": "A",
"authorized_official_last_name": "LANDERS",
"authorized_official_first_name": "MAERAN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "503-692-9525",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": "OR",
"license": "338484-90",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tualatin, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.