Provider Demographics
NPI:1053305193
Name:POREDA, MARGUERITE RAFFIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGUERITE
Middle Name:RAFFIO
Last Name:POREDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 CLASSICS DRIVE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-3345
Mailing Address - Country:US
Mailing Address - Phone:239-234-5978
Mailing Address - Fax:781-459-8187
Practice Address - Street 1:7703 CLASSICS DRIVE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-3345
Practice Address - Country:US
Practice Address - Phone:239-234-5978
Practice Address - Fax:781-459-8187
Is Sole Proprietor?:No
Enumeration Date:2005-09-05
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME846342084F0202X, 2084H0002X, 2084P0805X, 2084P0800X
LA0150742084F0202X, 2084H0002X, 2084P0800X, 2084P0805X
MA466802084F0202X, 2084H0002X, 2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084H0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyHospice and Palliative Medicine
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51532OtherBCBS
FL265073800Medicaid
FL265073800Medicaid