Healthcare Provider Details

I. General information

NPI: 1689066714
Provider Name (Legal Business Name): THOMAS R PORTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CALL RD
MILFORD ME
04461
US

IV. Provider business mailing address

15 CALL RD
MILFORD ME
04461
US

V. Phone/Fax

Practice location:
  • Phone: 207-817-0329
  • Fax: 207-817-0329
Mailing address:
  • Phone: 207-817-0329
  • Fax: 207-817-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: