1437137346 NPI number — DR. ROBERT B PORTNEY MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437137346 NPI number — DR. ROBERT B PORTNEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTNEY
Provider First Name:
ROBERT
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437137346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 HEARTHSTONE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01810-5421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-470-3178
Provider Business Mailing Address Fax Number:
978-475-0502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 HEARTHSTONE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01810-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-470-3178
Provider Business Practice Location Address Fax Number:
978-475-0502
Provider Enumeration Date:
01/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0805X , with the licence number:  15846 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: 53057 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3022056 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0122499 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53057 . This is a "MASS REGISTRATION" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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