Provider Demographics
NPI:1821110388
Name:HANLON-MILANESA, STACEY CORINNE (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:CORINNE
Last Name:HANLON-MILANESA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LEWIS WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-5371
Mailing Address - Country:US
Mailing Address - Phone:831-206-7193
Mailing Address - Fax:
Practice Address - Street 1:300 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1631
Practice Address - Country:US
Practice Address - Phone:304-728-1795
Practice Address - Fax:304-728-1796
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76269207L00000X
WV31145207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology