Provider Demographics
NPI:1285942078
Name:DO, MADELYN DAN (PA)
Entity type:Individual
Prefix:MS
First Name:MADELYN
Middle Name:DAN
Last Name:DO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:THANH
Other - Middle Name:DAN
Other - Last Name:DO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:
Practice Address - Street 1:9155 SW BARNES RD STE 238
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6629
Practice Address - Country:US
Practice Address - Phone:503-216-6407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA162008363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1285942078Medicaid
OR500656356Medicaid
OR500656356Medicaid