Provider Demographics
NPI:1902861255
Name:PORTER, TALMAGE N (MD)
Entity Type:Individual
Prefix:DR
First Name:TALMAGE
Middle Name:N
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 1:4700 SMITH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2787
Mailing Address - Country:US
Mailing Address - Phone:513-619-6819
Mailing Address - Fax:513-645-2393
Practice Address - Street 1:979 CONGRESS PARK DRIVE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4009
Practice Address - Country:US
Practice Address - Phone:937-435-9013
Practice Address - Fax:937-435-9013
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036308P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0290617Medicaid
OHC01082Medicare UPIN
OH0394397Medicare PIN
OH0395394Medicare PIN
OH0394396Medicare PIN
OH0290617Medicaid
OH0394395Medicare PIN
080024403Medicare PIN