Provider Demographics
NPI:1730125667
Name:BONAFEDE, ROSARIO P (MD)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:P
Last Name:BONAFEDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R PETER
Other - Middle Name:
Other - Last Name:BONAFEDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:STE 155
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2956
Practice Address - Country:US
Practice Address - Phone:503-215-6819
Practice Address - Fax:503-215-6492
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16090207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00745121OtherRR MEDICARE
OR054416Medicaid
ORE68670Medicare UPIN
ORR148071Medicare PIN