Healthcare Provider Details

I. General information

NPI: 1437137346
Provider Name (Legal Business Name): ROBERT B PORTNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HEARTHSTONE PL
ANDOVER MA
01810-5421
US

IV. Provider business mailing address

6 HEARTHSTONE PL
ANDOVER MA
01810-5421
US

V. Phone/Fax

Practice location:
  • Phone: 978-470-3178
  • Fax: 978-475-0502
Mailing address:
  • Phone: 978-470-3178
  • Fax: 978-475-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number15846
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number53057
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: