Provider Demographics
NPI:1083811640
Name:PORTER, SARAH GRACE (DO)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:GRACE
Last Name:PORTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8034
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:246 COMMONWEALTH RD
Practice Address - Street 2:
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179
Practice Address - Country:US
Practice Address - Phone:606-796-0010
Practice Address - Fax:606-796-0011
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100017660Medicaid
KY7100017660Medicaid
KY0055647Medicare PIN