Provider Demographics
NPI:1295763381
Name:PORTNOY, EDWARD BARRY (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BARRY
Last Name:PORTNOY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:32144 AGOURA RD
Mailing Address - Street 2:STE 218
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4056
Mailing Address - Country:US
Mailing Address - Phone:805-497-9272
Mailing Address - Fax:805-497-7082
Practice Address - Street 1:32144 AGOURA RD
Practice Address - Street 2:STE 218
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4056
Practice Address - Country:US
Practice Address - Phone:805-497-9272
Practice Address - Fax:805-497-7082
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG30207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44332Medicare UPIN
CACB265295Medicare Oscar/Certification