Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | D0059521 | MD |
NPI | 1831259571 |
---|---|
Provider Name | Dr. Jennifer P Porter |
First Address | Bethesda, MD 20814-4810 |
Second Address | Bethesda, MD 20814-4810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 14/10/2015 |