Provider Demographics
NPI:1437137346
Name:PORTNEY, ROBERT B (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:PORTNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HEARTHSTONE PL
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-5421
Mailing Address - Country:US
Mailing Address - Phone:978-470-3178
Mailing Address - Fax:978-475-0502
Practice Address - Street 1:6 HEARTHSTONE PL
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-5421
Practice Address - Country:US
Practice Address - Phone:978-470-3178
Practice Address - Fax:978-475-0502
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH158462084P0805X
MA530572084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3022056Medicaid
NY0122499Medicaid
MA53057OtherMASS REGISTRATION
MA53057OtherMASS REGISTRATION
NY0122499Medicaid