Provider Demographics
NPI:1699745299
Name:PORTER, JAY W III (DO)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:W
Last Name:PORTER
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-4516
Mailing Address - Country:US
Mailing Address - Phone:724-342-1070
Mailing Address - Fax:724-342-5220
Practice Address - Street 1:3150 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4516
Practice Address - Country:US
Practice Address - Phone:724-342-1070
Practice Address - Fax:724-342-5220
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019690620004Medicaid
PA0019690620004Medicaid
PA069146Medicare ID - Type Unspecified