Theodore B Porter, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS003735L Issued in PA

Practice address

1413 W Moyamensing Ave
1St Floor
Philadelphia, PA 19145-4625

Phone

(267) 639-2555

Fax

(267) 639-2632

NPI assigned

Jul 14, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363046400000",
    "number": "1689672479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1413 W MOYAMENSING AVE",
            "address_2": "1ST FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191454625",
            "telephone_number": "267-639-2555",
            "fax_number": "267-639-2632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1413 W MOYAMENSING AVE",
            "address_2": "1ST FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191454625",
            "telephone_number": "267-639-2555",
            "fax_number": "267-639-2632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "THEODORE",
        "middle_name": "B",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2013-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS003735L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katharine Porter
• Michelle M. Porter, RD, LDN
• Rebecca Degraff Porter, MD
• Robert Sherman Porter, M.D.
• Stanley M Porter, DENTIST
• Cecilia Porth
• Yvette Portilla, MD
• Guillermo Portillo Jr., M.D.
• Lisa Portnoy
• Jaclyn Anne Portogallo

• Family Medicine Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.