Provider Demographics
NPI:1679509525
Name:WINTHROP, KEVIN LORING (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:LORING
Last Name:WINTHROP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 SW TERWILLIGER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4146
Mailing Address - Country:US
Mailing Address - Phone:503-494-7890
Mailing Address - Fax:503-494-0470
Practice Address - Street 1:3375 SW TERWILLIGER BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4146
Practice Address - Country:US
Practice Address - Phone:503-494-7890
Practice Address - Fax:503-494-0470
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25331207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8457194Medicaid
ORR143119OtherMEDICARE ID#
OR240073Medicaid
WA8457194Medicaid