| Doctor Name: | ROMAN PORTNOY |
| NPI Number: | 1225340391 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 244628 |
| Business Practice Address: | 75 Francis St Cwn L1 Boston, MA - 021156110 |
| Business Phone Number: | 6177328210 |
| Business Fax Number: | |
| Mailing Address: | 75 Francis St, Cwn L1 BOSTON |
| State: | MA |
| Postal Code: | 021156110 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/06/2010 |
| NPI Last Update Date: | 05/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 244628 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |