Provider Demographics
NPI:1538173604
Name:DORTONE, KENNETH JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JAMES
Last Name:DORTONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CARR LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3009
Mailing Address - Country:US
Mailing Address - Phone:610-543-6488
Mailing Address - Fax:
Practice Address - Street 1:2429 BROWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1930
Practice Address - Country:US
Practice Address - Phone:215-236-4088
Practice Address - Fax:215-236-0755
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003609L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014109700006Medicaid
PA0014109700006Medicaid
PA711034Medicare PIN