Healthcare Provider Details

I. General information

NPI: 1538173604
Provider Name (Legal Business Name): KENNETH JAMES DORTONE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 BROWN ST
PHILADELPHIA PA
19130-1930
US

IV. Provider business mailing address

209 CARR LN
SPRINGFIELD PA
19064-3009
US

V. Phone/Fax

Practice location:
  • Phone: 215-236-4088
  • Fax: 215-236-0755
Mailing address:
  • Phone: 610-543-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC003609L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: