Provider Demographics
NPI:1861551616
Name:PATRICK L HANLEY MD PC
Entity type:Organization
Organization Name:PATRICK L HANLEY MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUKAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-256-5866
Mailing Address - Street 1:10000 SE MAIN ST
Mailing Address - Street 2:SUITE 327
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2448
Mailing Address - Country:US
Mailing Address - Phone:503-256-5866
Mailing Address - Fax:503-254-0655
Practice Address - Street 1:10000 SE MAIN ST
Practice Address - Street 2:SUITE 327
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2448
Practice Address - Country:US
Practice Address - Phone:503-256-5866
Practice Address - Fax:503-254-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0397507-8207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR101096Medicare PIN