Individual
DIDIER PORTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5 HOSPITAL DR, CHARLOTTESVILLE, VA 22908-0001
(434) 924-5125
(434) 924-5848
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
0101257080
VA
207RN0300X
Nephrology Physician
R-4238
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121269001
—
AR
01
—
390004629
RAILROAD MEDICARE
AR
Enumeration date
10/13/2006
Last updated
12/23/2014
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