Provider Demographics
NPI:1679853949
Name:PORTNOY, ALISON DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:DEAN
Last Name:PORTNOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:108 TRIANON LN
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1441
Mailing Address - Country:US
Mailing Address - Phone:610-517-7273
Mailing Address - Fax:425-645-1317
Practice Address - Street 1:108 TRIANON LN
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1441
Practice Address - Country:US
Practice Address - Phone:610-517-7273
Practice Address - Fax:425-645-1317
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417672207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH61422Medicare UPIN