Provider Demographics
NPI:1336341296
Name:PORCHEY, CARL J (MD)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:J
Last Name:PORCHEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1109 BOULDER RD
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-5609
Mailing Address - Country:US
Mailing Address - Phone:336-961-4574
Mailing Address - Fax:336-679-6744
Practice Address - Street 1:624 W MAIN ST
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-7804
Practice Address - Country:US
Practice Address - Phone:336-679-2041
Practice Address - Fax:336-679-6744
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC651207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC82354Medicare UPIN