Provider Demographics
NPI:1215989959
Name:PORCARI, JULIET M (PA)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:M
Last Name:PORCARI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DUDLEY ST
Mailing Address - Street 2:STE 460
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905
Mailing Address - Country:US
Mailing Address - Phone:401-453-0120
Mailing Address - Fax:401-453-0198
Practice Address - Street 1:2 DUDLEY ST
Practice Address - Street 2:STE 460
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905
Practice Address - Country:US
Practice Address - Phone:401-453-0120
Practice Address - Fax:401-453-0198
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00299363A00000X
PAMA062550363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI228635OtherBLUE SHIELD
RI410510OtherBLUE CHIP
P61963Medicare UPIN