Provider Demographics
NPI:1194554998
Name:MDPORTAL NETWORK LLC
Entity type:Organization
Organization Name:MDPORTAL NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZING REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SESSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-282-4020
Mailing Address - Street 1:5830 E 2ND ST STE 7000
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4308
Mailing Address - Country:US
Mailing Address - Phone:929-282-4020
Mailing Address - Fax:929-282-4020
Practice Address - Street 1:5830 E 2ND ST STE 7000
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4308
Practice Address - Country:US
Practice Address - Phone:929-282-4020
Practice Address - Fax:929-282-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management