Provider Demographics
NPI:1831259571
Name:PORTER, JENNIFER P (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:P
Last Name:PORTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 WISCONSIN AVE
Mailing Address - Street 2:SUITE 515
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4810
Mailing Address - Country:US
Mailing Address - Phone:301-652-8191
Mailing Address - Fax:
Practice Address - Street 1:7201 WISCONSIN AVE
Practice Address - Street 2:SUITE 515
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4810
Practice Address - Country:US
Practice Address - Phone:301-652-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059521207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery