Provider Demographics
NPI:1255606521
Name:PORTER, CATHERINE MELISSA (DO)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MELISSA
Last Name:PORTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:MELISSA
Other - Last Name:MARKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 OLD FERN ROAD
Mailing Address - Street 2:BLDNG D STE 503 2ND FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4629
Mailing Address - Country:US
Mailing Address - Phone:610-423-4556
Mailing Address - Fax:610-732-6735
Practice Address - Street 1:915 OLD FERN ROAD
Practice Address - Street 2:BLDNG D STE 503 2ND FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19380-4629
Practice Address - Country:US
Practice Address - Phone:610-423-4556
Practice Address - Fax:610-732-6735
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014585208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery