Provider Demographics
NPI:1922079607
Name:PORTER, JAMES AUSTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:AUSTIN
Last Name:PORTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 BRAEBURN DR
Mailing Address - Street 2:SUITE M120
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7357
Mailing Address - Country:US
Mailing Address - Phone:540-344-3668
Mailing Address - Fax:540-774-4615
Practice Address - Street 1:1802 BRAEBURN DR
Practice Address - Street 2:SUITE M120
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7357
Practice Address - Country:US
Practice Address - Phone:540-344-3668
Practice Address - Fax:540-774-4615
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840594363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00363084Medicare PIN
S48307Medicare UPIN
VA011577F35Medicare PIN