Provider Demographics
NPI:1295058154
Name:FRANCIS R. PORTER MD
Entity type:Organization
Organization Name:FRANCIS R. PORTER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-395-0126
Mailing Address - Street 1:352 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6157
Mailing Address - Country:US
Mailing Address - Phone:781-395-0126
Mailing Address - Fax:781-395-7170
Practice Address - Street 1:352 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6157
Practice Address - Country:US
Practice Address - Phone:781-395-0126
Practice Address - Fax:781-395-7170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA65039OtherHARVARD PILGRIM HEALTHCARE
MA739971OtherTUFTS ASSOCIATED HEALTH PLAN (TAHP)
MA70010000B30164OtherBLUE CROSS/BLUE SHIELD (BC/BS)
MA0145653Medicaid
739971OtherTUFTS ASSOCIATED HEALTH PLAN (TAHP)
MA70010000B30164OtherBLUE CROSS/BLUE SHIELD (BC/BS)