Provider Demographics
NPI:1417993627
Name:PORTER, ANNE M (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:PORTER
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:HUNTERDON DEVELOPMENTAL CENTER
Mailing Address - Street 2:40 PITTSTOWN ROAD
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-4003
Mailing Address - Country:US
Mailing Address - Phone:908-735-4031
Mailing Address - Fax:908-730-1340
Practice Address - Street 1:HUNTERDON DEVELOPMENTAL CENTER
Practice Address - Street 2:40 PITTSTOWN ROAD
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-4003
Practice Address - Country:US
Practice Address - Phone:908-735-4031
Practice Address - Fax:908-730-1340
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07842600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095895B1LOtherMEDICARE BILLING NO.
NJH53308Medicare UPIN