Provider Demographics
NPI:1063042034
Name:ALEXANDER, PORCHER
Entity Type:Individual
Prefix:
First Name:PORCHER
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 GOLF RD STE 22
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1475
Mailing Address - Country:US
Mailing Address - Phone:267-743-8336
Mailing Address - Fax:
Practice Address - Street 1:2449 GOLF RD STE 22
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1475
Practice Address - Country:US
Practice Address - Phone:267-743-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-18
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver