Provider Demographics
NPI:1861573347
Name:JOSEPH P SONDERLEITER, MD, PC
Entity type:Organization
Organization Name:JOSEPH P SONDERLEITER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SONDERLEITER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-223-7563
Mailing Address - Street 1:5410 SW MACADAM AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-223-7563
Mailing Address - Fax:503-223-7564
Practice Address - Street 1:5410 SW MACADAM AVE
Practice Address - Street 2:STE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6105
Practice Address - Country:US
Practice Address - Phone:503-223-7563
Practice Address - Fax:503-223-7564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD244112084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG61900Medicare UPIN