Healthcare Provider Details

I. General information

NPI: 1508849084
Provider Name (Legal Business Name): MARGARET M. PORTWOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: PEGGY PORTWOOD MD

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 J ST STE. 435
SACRAMENTO CA
95816-4300
US

IV. Provider business mailing address

2825 J ST STE. 435
SACRAMENTO CA
95816-4300
US

V. Phone/Fax

Practice location:
  • Phone: 916-440-8005
  • Fax: 916-440-1030
Mailing address:
  • Phone: 916-440-8005
  • Fax: 916-440-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG38758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: