Provider Demographics
NPI:1548598964
Name:PORTER, CHARLOTTE MILES
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:MILES
Last Name:PORTER
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 1:9210 HANOVER CV
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2947
Mailing Address - Country:US
Mailing Address - Phone:210-251-2922
Mailing Address - Fax:
Practice Address - Street 1:9210 HANOVER CV
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2947
Practice Address - Country:US
Practice Address - Phone:210-251-2922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory