Provider Demographics
NPI:1811993793
Name:PORTER, JOEL A (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:A
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 1:95 ARCH ST
Mailing Address - Street 2:STE 150
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1479
Mailing Address - Country:US
Mailing Address - Phone:330-564-0728
Mailing Address - Fax:330-564-0733
Practice Address - Street 1:95 ARCH ST
Practice Address - Street 2:STE 150
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1479
Practice Address - Country:US
Practice Address - Phone:330-564-0728
Practice Address - Fax:330-564-0733
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048232O174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000029383OtherANTHEM BC BS
OH0681525Medicaid
OHA16952Medicare UPIN
OH0681525Medicaid