Healthcare Provider Details

I. General information

NPI: 1720194079
Provider Name (Legal Business Name): AMY PORTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 PARK AVE STE 300
FALLS CHURCH VA
22046-3305
US

IV. Provider business mailing address

431 PARK AVE STE 300
FALLS CHURCH VA
22046-3305
US

V. Phone/Fax

Practice location:
  • Phone: 703-528-6300
  • Fax: 703-525-1967
Mailing address:
  • Phone: 703-528-6300
  • Fax: 703-525-1967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101226832
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number0101226832
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: