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Individual

DR. CYNTHIA L POORTENGA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
121 E RAVINE RD, STE 900, KINGSPORT, TN 37660-3800
(423) 230-4800
(423) 230-4808
Mailing address
121 E RAVINE RD, STE 900, KINGSPORT, TN 37660-3800
(423) 230-4800
(423) 230-4808

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD0000017131
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
246269
ANTHEM BCBS VA
VA
05
3372564
TN
01
4054392
BCBS TN
TN
01
5645956
VA MEDICAID
VA
01
830342546-01
JOHN DEERE HEALTH INS
TN
Enumeration date
06/09/2005
Last updated
02/27/2008
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