Provider Demographics
NPI:1639296577
Name:SALVADOR C. PORTUGAL MD, INC.
Entity Type:Organization
Organization Name:SALVADOR C. PORTUGAL MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:C
Authorized Official - Last Name:PORTUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-766-3482
Mailing Address - Street 1:PO BOX 9288
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-0288
Mailing Address - Country:US
Mailing Address - Phone:304-766-3482
Mailing Address - Fax:
Practice Address - Street 1:400 DIVISION ST
Practice Address - Street 2:SUITE 9
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1459
Practice Address - Country:US
Practice Address - Phone:304-766-3482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13580207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty