Provider Demographics
NPI:1659354884
Name:PORTER, GEORGE ARTHUR JR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ARTHUR
Last Name:PORTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:YNHH CHILDREN'S HOSPITAL - 2ND FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-785-4081
Mailing Address - Fax:203-737-2786
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YNHH CHILDREN'S HOSPITAL - 2ND FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-785-4081
Practice Address - Fax:203-737-2786
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2512362080P0202X
CT0371932080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001371939Medicaid
C93553Medicare UPIN
CT001371939Medicaid