Provider Demographics
NPI:1851350375
Name:PORTER, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:PORTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3316
Mailing Address - Country:US
Mailing Address - Phone:304-697-4497
Mailing Address - Fax:304-523-9470
Practice Address - Street 1:1001 10TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3316
Practice Address - Country:US
Practice Address - Phone:304-697-4497
Practice Address - Fax:304-523-9470
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12906207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0104489000Medicaid
KY64695802Medicaid
OH0530938Medicaid
KY64695802Medicaid
WVA72806Medicare UPIN