Provider Demographics
NPI:1720309032
Name:PORTER, DANIEL ROBERT (PA-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ROBERT
Last Name:PORTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:995 GREENTREE RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-3242
Mailing Address - Country:US
Mailing Address - Phone:412-921-5101
Mailing Address - Fax:412-921-5106
Practice Address - Street 1:995 GREENTREE RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-3242
Practice Address - Country:US
Practice Address - Phone:412-921-5101
Practice Address - Fax:412-921-5106
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOA002480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant