Provider Demographics
NPI:1861753352
Name:HILDE, ANANDAM (MD)
Entity type:Individual
Prefix:DR
First Name:ANANDAM
Middle Name:
Last Name:HILDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:HILDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3580 SE 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-2902
Mailing Address - Country:US
Mailing Address - Phone:971-339-9240
Mailing Address - Fax:
Practice Address - Street 1:3580 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-2902
Practice Address - Country:US
Practice Address - Phone:971-339-9240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1803852084P0804X, 2084P0804X
103TA0400X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2063589Medicaid
OR500743795Medicaid