| David M Portner, Ph.d. Plc | |
|
1428 Water Mill Cir Virginia Beach VA 23454-1359 | |
| (757) 642-2567 | |
| (757) 233-0201 |
| Full Name | David M Portner, Ph.d. Plc |
|---|---|
| Speciality | Psychologist |
| Location | 1428 Water Mill Cir, Virginia Beach, Virginia |
| Authorized Official Name and Position | David Michael Portner (OWNER) |
| Authorized Official Contact | 7576422567 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David M Portner, Ph.d. Plc 1428 Water Mill Cir Virginia Beach VA 23454-1359 Ph: (757) 642-2567 | David M Portner, Ph.d. Plc 1428 Water Mill Cir Virginia Beach VA 23454-1359 Ph: (757) 642-2567 |
| NPI Number | 1699215970 |
|---|---|
| Provider Enumeration Date | 03/06/2017 |
| Last Update Date | 03/06/2017 |
| Medicare PECOS PAC ID | 9537439542 |
|---|---|
| Medicare Enrollment ID | O20170725001509 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699215970 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 0810001188 (Virginia) | Primary |
| Provider Name | David M Portner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063510238 PECOS PAC ID: 8729165824 Enrollment ID: I20080430000270 |
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