Provider Demographics
NPI:1053638296
Name:PORWAL, ANJANA HEMRAJ (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANJANA
Middle Name:HEMRAJ
Last Name:PORWAL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7770 CAMERON COURT
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L2H3G9
Mailing Address - Country:CA
Mailing Address - Phone:905-356-7847
Mailing Address - Fax:
Practice Address - Street 1:6970 ERIE RD STE A
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9591
Practice Address - Country:US
Practice Address - Phone:716-947-9147
Practice Address - Fax:716-947-9147
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012825363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical