Provider Demographics
NPI:1508354531
Name:PORRECA, LOUIS PHILLIP
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:PHILLIP
Last Name:PORRECA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-988-3444
Mailing Address - Fax:856-988-0553
Practice Address - Street 1:1001 RT. 73 NORTH, MAIN LEVEL
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-988-3444
Practice Address - Fax:856-988-0553
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA122155002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology