MEDICARE: DARIN A PORTNOY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	236138	NY

General Provider Information

NPI Number	:	1629153739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARIN A PORTNOY MD

Provider Business Mailing Address
First Line	:	PO BOX 746087
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6087
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:

Provider Business Practice Location Address
First Line	:	1114 LIBERTY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2922
Country	:	US
Telephone Number	:	718-765-6058
Fax Number	:	347-808-4895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	09/27/2023

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