Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 0101256120 | VA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 0101256120 | VA |
NPI | 1033434170 |
---|---|
Provider Name | Lea Porche |
First Address | Norfolk, VA 23501-0936 |
Second Address | Norfolk, VA 23507-1914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2010 |
Last Update Date | 28/04/2017 |