Provider Demographics
NPI:1285880617
Name:ELI PORTH DO PA
Entity type:Organization
Organization Name:ELI PORTH DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-678-8000
Mailing Address - Street 1:1120 STATE ROAD 436
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6100
Mailing Address - Country:US
Mailing Address - Phone:407-678-8000
Mailing Address - Fax:
Practice Address - Street 1:1120 STATE ROAD 436
Practice Address - Street 2:SUITE 1200
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6100
Practice Address - Country:US
Practice Address - Phone:407-678-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3835207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty