Provider Demographics
NPI:1720344872
Name:MILANESE, ERIC DANIEL (PA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DANIEL
Last Name:MILANESE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 SW BOND AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-494-5501
Mailing Address - Fax:503-494-8884
Practice Address - Street 1:3303 SW BOND AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-5501
Practice Address - Fax:503-494-8884
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1529363AS0400X
OR173362363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN970006126Medicare UPIN