Provider Demographics
NPI:1588801898
Name:PORTER, PAUL S JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:PORTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1500 COCHRAN RD APT 612
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1066
Mailing Address - Country:US
Mailing Address - Phone:973-255-0868
Mailing Address - Fax:401-854-2519
Practice Address - Street 1:2120 L ST NW STE 450
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1541
Practice Address - Country:US
Practice Address - Phone:973-255-0868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13059207P00000X
390200000X
CT62553207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI10/27/2009OtherBCBS
RI001261801OtherMEDICARE
RI1962455022OtherUEMF GROUP NPI
RI10/08/2009OtherNHPRI
MA10/27/2009OtherTUFTS HEALTH PLAN
RIPP76984Medicaid
RI939025129OtherMEDICARE GROUP NUMBER
RI07/14/2009OtherUNITED HEALTH CARE