Healthcare Provider Details

I. General information

NPI: 1750380549
Provider Name (Legal Business Name): WILLIAM EDWARD PORTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WILLIAM E PORTER MD

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6324 FAIRVIEW RD STE 420
CHARLOTTE NC
28210-3372
US

IV. Provider business mailing address

PO BOX 604136
CHARLOTTE NC
28260-4136
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-1120
  • Fax: 704-316-1121
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number2007-01871
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2007-01871
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: