Individual
ELLEN GALE MADNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10373 NE HANCOCK ST STE 200, PORTLAND, OR 97220-3873
(503) 253-6754
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD14792
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117549
—
OR
Enumeration date
07/31/2006
Last updated
10/23/2020
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