Provider Demographics
NPI:1578799086
Name:MILANO, CONCETTA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CONCETTA
Middle Name:MARIA
Last Name:MILANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CONCETTA
Other - Middle Name:MARIA
Other - Last Name:NESTICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19170-1500
Mailing Address - Country:US
Mailing Address - Phone:215-389-3890
Mailing Address - Fax:215-551-0368
Practice Address - Street 1:1809 W OREGON AVE # 13
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145
Practice Address - Country:US
Practice Address - Phone:215-389-3890
Practice Address - Fax:215-551-0368
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453415207RC0000X, 174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103020609 0001Medicaid
PA414208Medicare PIN