Provider Demographics
NPI:1629055447
Name:PORTNER, CINDY J (DO)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:J
Last Name:PORTNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:P
Other - Last Name:MARGOLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 945921
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-5921
Mailing Address - Country:US
Mailing Address - Phone:386-231-4529
Mailing Address - Fax:386-672-9904
Practice Address - Street 1:301 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5167
Practice Address - Country:US
Practice Address - Phone:386-231-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0052675207L00000X
VA0102201838207L00000X
FLOS20470207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA033579OtherANTHEM
VA484645OtherNCPPO
VAK142-0001OtherCAREFIRST
VA1629055447Medicaid
VA31116OtherAMERIGROUP
G81799Medicare UPIN
VA1629055447Medicaid
DC020785F89Medicare PIN