Provider Demographics
NPI:1326937897
Name:PORTER, LATANYA RENEE
Entity type:Individual
Prefix:
First Name:LATANYA
Middle Name:RENEE
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14711 MAIN ST # B
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3014
Mailing Address - Country:US
Mailing Address - Phone:240-339-1231
Mailing Address - Fax:
Practice Address - Street 1:14711 MAIN ST # B
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3014
Practice Address - Country:US
Practice Address - Phone:240-339-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist