Healthcare Provider Details

I. General information

NPI: 1275023160
Provider Name (Legal Business Name): JOHN THOMAS PONTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300A FAUNCE CORNER RD
NORTH DARTMOUTH MA
02747-1280
US

IV. Provider business mailing address

200 MILL RD STE 180
FAIRHAVEN MA
02719-5255
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-2211
  • Fax: 508-973-1105
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number287674
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: