Individual provider Active NPI

Maureen M Mulcahy, M.D.

  • Otology & Neurotology Physician
  • Lake Oswego, OR
National Provider Identifier
1275539561
Registry record updated Sep 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otology & Neurotology PhysicianTaxonomy code 207YX0901X
License
MD18995 Issued in OR
Practice address
17704 Jean Way
Lake Oswego, OR 97035-5497
Phone
(503) 699-0370
Fax
(971) 236-9099
NPI assigned
Jun 22, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otology & Neurotology Physician 207YX0901X MD18995 OR Primary

Addresses

Primary practice location

17704 Jean Way
Lake Oswego, OR 97035-5497

Mailing address

17704 Jean Way
Suite 101
Lake Oswego, OR 97035
Phone (503) 699-0370

Other identifiers 1

IdentifierTypeStateIssuer
130048MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD18995ORMDOtology & Neurotology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Entoffice.Org, PLLC PastSince Sep 19, 2018 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537315200000",
    "number": "1275539561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17704 JEAN WAY",
            "address_2": "SUITE 101",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "97035",
            "telephone_number": "503-699-0370",
            "fax_number": "971-236-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17704 JEAN WAY",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970355497",
            "telephone_number": "503-699-0370",
            "fax_number": "971-236-9099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULCAHY",
        "first_name": "MAUREEN",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-22",
        "last_updated": "2018-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "OR",
            "license": "MD18995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130048",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.