Provider Demographics
NPI:1972687085
Name:PORTO, ANDREA S (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:S
Last Name:PORTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:S
Other - Last Name:PALERMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-6309
Mailing Address - Country:US
Mailing Address - Phone:609-567-0200
Mailing Address - Fax:609-704-5615
Practice Address - Street 1:1125 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401
Practice Address - Country:US
Practice Address - Phone:609-348-0066
Practice Address - Fax:609-348-1157
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB06634300208M00000X
NJ25MB06634300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02588172Medicaid
MD7666021Medicaid
PA001776870Medicaid
NJ8255300Medicaid
NY02588172Medicaid