Provider Demographics
NPI:1588801898
Name:PORTER, PAUL S JR (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:PORTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12170 ABINGTON HALL PL APT 304
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5850
Mailing Address - Country:US
Mailing Address - Phone:973-255-0868
Mailing Address - Fax:
Practice Address - Street 1:4494 PALMER RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-1541
Practice Address - Country:US
Practice Address - Phone:301-295-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13059207P00000X
CT62553207P00000X
390200000X
MDD0091252207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI001261801OtherMEDICARE
RI07/14/2009OtherUNITED HEALTH CARE
RI1962455022OtherUEMF GROUP NPI
MA10/27/2009OtherTUFTS HEALTH PLAN
RI10/08/2009OtherNHPRI
RI10/27/2009OtherBCBS
RI939025129OtherMEDICARE GROUP NUMBER
RIPP76984Medicaid