Healthcare Provider Details

I. General information

NPI: 1578176277
Provider Name (Legal Business Name): DENNIS A PORTO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAPLE ST STE 2
MILFORD MA
01757-5614
US

IV. Provider business mailing address

200 BROOKLINE AVE UNIT 707
BOSTON MA
02215-3953
US

V. Phone/Fax

Practice location:
  • Phone: 508-478-2610
  • Fax:
Mailing address:
  • Phone: 515-201-7667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DENNIS A PORTO
Title or Position: OWNER/CEO
Credential: MD
Phone: 508-478-2610