Organization
CYNTHIA POORTENGA, MD PC
Active
Other names
Cynthia Poortenga, MD PC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CYNTHIA L POORTENGA M.D. (PRESIDENT)
(423) 230-4800
Entity
Organization
Contact information
Practice address
121 E RAVINE RD, STE 900, KINGSPORT, TN 37660-3816
(423) 230-4800
(423) 230-4808
Mailing address
121 E RAVINE RD, STE 900, KINGSPORT, TN 37660-3816
(423) 230-4800
(423) 230-4808
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
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
05
—
5645956
—
VA
Enumeration date
11/16/2006
Last updated
04/20/2008
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