Provider Demographics
NPI:1922508977
Name:PORTELA-COLON, RAFAEL ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ANTONIO
Last Name:PORTELA-COLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:ANTONIO VICENTE
Other - Last Name:PORTELA COLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:500 UNIVERSITY DR MC CA410
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-5208
Mailing Address - Fax:717-531-0119
Practice Address - Street 1:1150 COCOA AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1712
Practice Address - Country:US
Practice Address - Phone:717-531-6015
Practice Address - Fax:717-531-0140
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD489615207RN0300X
PR6132271390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program