Healthcare Provider Details

I. General information

NPI: 1922508977
Provider Name (Legal Business Name): RAFAEL ANTONIO PORTELA-COLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAFAEL ANTONIO VICENTE PORTELA COLON MD

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 COCOA AVE
HERSHEY PA
17033-1712
US

IV. Provider business mailing address

500 UNIVERSITY DR MC CA410
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-6015
  • Fax: 717-531-0140
Mailing address:
  • Phone: 717-531-5208
  • Fax: 717-531-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD489615
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: