Provider Demographics
NPI:1427055789
Name:PORCARI, ANGELO (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:
Last Name:PORCARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-2532
Mailing Address - Country:US
Mailing Address - Phone:315-598-5373
Mailing Address - Fax:315-598-2304
Practice Address - Street 1:361 S 4TH ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2532
Practice Address - Country:US
Practice Address - Phone:315-598-5373
Practice Address - Fax:315-598-2304
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010647146OtherEMPIRE PLAN
NY010647146OtherPOMCO
NY990270OtherMVP
NY4479OtherTOTAL CARE
NY010647146OtherCIGNA HEALTHCARE
NY010647146OtherUNITED HEALTHCARE
NY110060046OtherRAILROAD MEDICARE
NY000915959002OtherHEALTHNOW
NY01114900OtherBLUE CROSS BLUE SHIELD UT
NY2501803OtherGHI
NY000002160OtherBLUE CROSS BLUE SHIELD CE
NY01342709Medicaid
NY010647146OtherEMPIRE PLAN
NY000002160OtherBLUE CROSS BLUE SHIELD CE
NYCC8459Medicare PIN
NY4479OtherTOTAL CARE