Healthcare Provider Details

I. General information

NPI: 1932033271
Provider Name (Legal Business Name): CLARENCE RAY PORCHIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 DEFENSE HWY STE 401
CROFTON MD
21114-2943
US

IV. Provider business mailing address

7833 CRYSTAL BROOK WAY
HANOVER MD
21076-2047
US

V. Phone/Fax

Practice location:
  • Phone: 410-697-1235
  • Fax:
Mailing address:
  • Phone: 305-731-7174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU03211
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: