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General NPI Number Information
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NPI Number | 1477908184
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Entity Type | Individual
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Provider Name | MR. ANDREW E PORTER
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Gender | Male
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Dates
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Enumeration Date | 05/01/2016
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 4975 FOOTE RD STE 400
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City | MEDINA
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State | OH
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Zip | 44256-9048
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Country | US
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Telephone | 330-591-9038
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Fax | 330-722-8585
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Provider Business Mailing Address
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Address Line | 2000 AUBURN DR STE 350
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City | BEACHWOOD
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State | OH
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Zip | 44122-4327
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Country | US
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Telephone | 440-646-1600
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Fax | 440-646-1505
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1135037
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 503004730RX
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License Number State | OH
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