MEDICARE: DR. DANIELLE ALEXANDRA PORBUNDERWALA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	17527	NH

General Provider Information

NPI Number	:	1780027706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE ALEXANDRA PORBUNDERWALA D.O.

Provider Business Mailing Address
First Line	:	1750 ELM ST STE 201A
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03104-2903
Country	:	US
Telephone Number	:	603-668-6489
Fax Number	:	603-663-7884

Provider Business Practice Location Address
First Line	:	1750 ELM ST STE 201A
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03104-2903
Country	:	US
Telephone Number	:	603-668-6489
Fax Number	:	603-663-7884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	03/27/2024

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