Provider Demographics
NPI:1871617126
Name:MCDONALD, TASHA LEE (MD)
Entity type:Individual
Prefix:DR
First Name:TASHA
Middle Name:LEE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-0391
Mailing Address - Country:US
Mailing Address - Phone:503-561-5135
Mailing Address - Fax:503-561-6807
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:SUITE 1080
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3975
Practice Address - Country:US
Practice Address - Phone:503-561-5294
Practice Address - Fax:503-561-4789
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD271962085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500622951Medicaid
OR153785Medicare PIN