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General NPI Number Information
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NPI Number | 1790770543
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Entity Type | Individual
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Provider Name | RONALD PETER PORTADIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 3980 BLACK HORSE PIKE
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City | MAYS LANDING
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State | NJ
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Zip | 08330-3107
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Country | US
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Telephone | 609-625-1600
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Fax | 609-625-2610
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Provider Business Mailing Address
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Address Line | PO BOX 536
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City | VOORHEES
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State | NJ
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Zip | 08043-0536
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Country | US
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Telephone | 856-669-6050
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Fax | 856-651-0794
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 25MA02273800
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License Number State | NJ
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