Healthcare Provider Details

I. General information

NPI: 1245867340
Provider Name (Legal Business Name): STORM PORTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND AVE
SALEM MA
01970-2768
US

IV. Provider business mailing address

81 HIGHLAND AVE ATTN DR. STORM PORTNER
SALEM MA
01970
US

V. Phone/Fax

Practice location:
  • Phone: 978-741-1200
  • Fax:
Mailing address:
  • Phone: 978-741-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1026706
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: