Provider Demographics
NPI:1104829944
Name:PORTO, JOSEPH L (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:PORTO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 STATE RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2525
Mailing Address - Country:US
Mailing Address - Phone:610-789-3600
Mailing Address - Fax:610-789-6604
Practice Address - Street 1:3601 STATE RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2525
Practice Address - Country:US
Practice Address - Phone:610-789-3600
Practice Address - Fax:610-789-6604
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001861L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA480000786OtherRAILROAD
PA000507706Medicaid
PA0032740000OtherKEYSTONE HMO
PA0032740000OtherKEYSTONE HMO
PA480000786OtherRAILROAD