Provider Demographics
NPI:1053611566
Name:GONA, AMITHA (MD)
Entity type:Individual
Prefix:
First Name:AMITHA
Middle Name:
Last Name:GONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMITHA
Other - Middle Name:
Other - Last Name:GONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,
Mailing Address - Street 1:875 OAK ST SE STE 4030
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3984
Mailing Address - Country:US
Mailing Address - Phone:503-561-6444
Mailing Address - Fax:503-561-6440
Practice Address - Street 1:3025 RYAN DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5057
Practice Address - Country:US
Practice Address - Phone:503-485-0350
Practice Address - Fax:503-561-6442
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD207RR0500X, 207RR0500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500687580Medicaid
OR500687580Medicaid