MEDICARE: FREDERICK L PORKOLAB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MD016838E	PA
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	MD016838E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619936077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK L PORKOLAB MD

Provider Business Mailing Address
First Line	:	2781 LEECHBURG RD
Second Line	:
City	:	LOWER BURRELL
State	:	PA
Zip	:	15068
Country	:	US
Telephone Number	:	724-226-3345
Fax Number	:	724-226-2415

Provider Business Practice Location Address
First Line	:	4727 FRIENDSHIP AVE
Second Line	:	STE 180
City	:	PITTSBURGH
State	:	PA
Zip	:	15224-1779
Country	:	US
Telephone Number	:	412-235-5881
Fax Number	:	412-235-5878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	01/05/2011

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