MEDICARE: ROSARIO P BONAFEDE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	MD16090	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00745121	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730125667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSARIO P BONAFEDE MD

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:	503-215-6494
Fax Number	:	503-215-6644

Provider Business Practice Location Address
First Line	:	5050 NE HOYT ST
Second Line	:	STE 155
City	:	PORTLAND
State	:	OR
Zip	:	97213-2956
Country	:	US
Telephone Number	:	503-215-6819
Fax Number	:	503-215-6492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	10/08/2021

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Directions to “ ROSARIO P BONAFEDE MD” Practice Location

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