Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Manuel Enrique Portalatin, DO

Individual provider Surgery Physician · NPI 1710392246

Manuel Enrique Portalatin, DO is a General Surgery in Providence, Rhode Island. Qualified in 2014, 12 years ago. Practices with Lifespan Physician Group Inc, a 1,125-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in Illinois, Massachusetts and Rhode Island.

Years since qualifying
12
Licensed in
IL, MA, RI
In the registry since
2014
Specialties on file
5
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

2 Dudley St # OP1
Providence, RI 02905-3236
Phone: (401) 444-5471
Fax: (401) 444-4557
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 55 Fruit St, Boston, MA 02114-2621 — (617) 726-7712
  • 593 Eddy St, Providence, RI 02903-4923 — (401) 444-0326
  • 2 Dudley St Ste 470, Providence, RI 02905-3248 — (401) 553-8355

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence DO01505 (RI)
Surgical Critical Care Physician Taxonomy 2086S0102X · Licence DO01505 (RI)
Surgery Physician Taxonomy 208600000X · Licence 282996 (MA)
Surgical Critical Care Physician Taxonomy 2086S0102X · Licence 282996 (MA)
Surgery Physician Taxonomy 208600000X · Licence 036156256 (IL)

Record details

NPI number1710392246
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorYes
NPI enumeratedJune 23, 2014
Last updated in NPPESJuly 31, 2026
Certification dateJuly 31, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGENERAL SURGERY
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Lifespan Physician Group Inc — 1125 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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