Provider Demographics
NPI:1841206521
Name:PORWANCHER, RICHARD B (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:PORWANCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3831
Mailing Address - Country:US
Mailing Address - Phone:609-581-2000
Mailing Address - Fax:609-581-5450
Practice Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 411
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-3831
Practice Address - Country:US
Practice Address - Phone:609-581-2000
Practice Address - Fax:609-581-5450
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40394207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ440002476OtherRAILROAD MEDICARE
0148186000OtherKEYSTONE
33891OtherAETNA ID
NJ3708306Medicaid
223381766OtherTAX ID
MEP089OtherOXFORD #
142409OtherAMERIHEALTH
4096880OtherAETNA
142409OtherAMERIHEALTH
C54275Medicare UPIN
223381766OtherTAX ID
33891OtherAETNA ID