Individual
DAVID PORTELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, CLAVERICK 2, PROVIDENCE, RI 02903-4923
(401) 854-2504
(401) 854-2519
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(041) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD11206
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007010651
RI MEDICARE
RI
01
—
03012009
BCBSRI
RI
01
—
04-15-2009
UNITED HEALTHCARE
RI
01
—
10-08-2009
NHPRI
RI
01
—
12-29-2008
TUFTS HEALTH PLAN
MA
05
—
2022214
—
MA
05
—
7010651
—
RI
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
Enumeration date
07/28/2006
Last updated
09/18/2013
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