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General NPI Number Information
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NPI Number | 1447482732
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Entity Type | Individual
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Provider Name | DUSTIN MATHEW PORTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 2500 INVESTIGATION PKWY
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City | QUANTICO
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State | VA
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Zip | 22134-5173
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Country | US
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Telephone | 571-362-8561
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Fax |
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Provider Business Mailing Address
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Address Line | 13271 AMBLEWOOD DR
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City | MANASSAS
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State | VA
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Zip | 20112-7818
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Country | US
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Telephone | 903-508-9435
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101279209
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25895
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 25895
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License Number State | NE
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 0101279209
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License Number State | VA
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