Provider Demographics
NPI:1487830816
Name:PORTER, ELLEN ANNE (L AC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ANNE
Last Name:PORTER
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 HOLDER AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-3013
Mailing Address - Country:US
Mailing Address - Phone:410-404-5019
Mailing Address - Fax:
Practice Address - Street 1:5007 HOLDER AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-3013
Practice Address - Country:US
Practice Address - Phone:410-404-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01566171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist