Provider Demographics
NPI:1548246911
Name:PORTER, WILLIAM HARRISON (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HARRISON
Last Name:PORTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 PINE ST BLDG 4
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1043
Mailing Address - Country:US
Mailing Address - Phone:802-453-5028
Mailing Address - Fax:
Practice Address - Street 1:61 PINE ST BLDG 4
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1043
Practice Address - Country:US
Practice Address - Phone:802-453-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
48883OtherBLUE CROSS
VTOVN2197Medicaid
VTOVN2197Medicaid
48883OtherBLUE CROSS