1386664902 NPI number — LAURIE B PORTER D.O.

Table of content: LAURIE B PORTER D.O. (NPI 1386664902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386664902 NPI number — LAURIE B PORTER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTER
Provider First Name:
LAURIE
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRIGANDI
Provider Other First Name:
LAURIE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386664902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 ELKRIDGE LANDING RD
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
LINTHICUM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21090-2917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-462-5010
Provider Business Mailing Address Fax Number:
410-684-2031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 PROSPECT ST
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-3922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-577-3150
Provider Business Practice Location Address Fax Number:
603-577-3151
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207YX0905X , with the licence number:  13178 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: H0071533 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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