Healthcare Provider Details

I. General information

NPI: 1790770543
Provider Name (Legal Business Name): RONALD PETER PORTADIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 BLACK HORSE PIKE
MAYS LANDING NJ
08330-3107
US

IV. Provider business mailing address

PO BOX 536
VOORHEES NJ
08043-0536
US

V. Phone/Fax

Practice location:
  • Phone: 609-625-1600
  • Fax: 609-625-2610
Mailing address:
  • Phone: 856-669-6050
  • Fax: 856-651-0794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA02273800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: