MEDICARE: MR. DOUGLAS MILANO-JOHNSON PA

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	363A00000X	Physician Assistant	019006	NY
2	363AM0700X	Medical Physician Assistant	019006	NY
3	363AM0700X	Medical Physician Assistant	0109006	NY

General Provider Information

NPI Number	:	1770951873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS MILANO-JOHNSON PA

Provider Business Mailing Address
First Line	:	601 ELMWOOD AVE BOX 278984
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	919 WESTFALL RD BLDG C
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2638
Country	:	US
Telephone Number	:	585-341-7500
Fax Number	:

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

Provider Enumeration Date	:	09/04/2015
Last Update Date	:	06/09/2026

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