Provider Demographics
NPI:1689012510
Name:PORTO, DENNIS ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ANTHONY
Last Name:PORTO
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 1:200 BROOKLINE AVE UNIT 707
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3953
Mailing Address - Country:US
Mailing Address - Phone:508-478-2610
Mailing Address - Fax:
Practice Address - Street 1:1 MAPLE STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:508-478-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA271027207NS0135X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty