Provider Demographics
NPI:1457606865
Name:PORTONOVA, DAVID J (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:PORTONOVA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1935
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0935
Mailing Address - Country:US
Mailing Address - Phone:570-288-8881
Mailing Address - Fax:570-288-8065
Practice Address - Street 1:6850 LOWS RD STE 316
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8708
Practice Address - Country:US
Practice Address - Phone:570-387-2202
Practice Address - Fax:570-387-2203
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006404213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery