Provider Demographics
NPI:1366840241
Name:PORE, ADAM J (AA)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:PORE
Suffix:
Gender:M
Credentials:AA
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-3693
Mailing Address - Fax:614-688-9420
Practice Address - Street 1:410 W 10TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-8487
Practice Address - Fax:614-293-8153
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2024-10-10
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Provider Licenses
StateLicense IDTaxonomies
GA7445367H00000X
NC1000-00667367H00000X
OH67.000241367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant