Provider Demographics
NPI:1619936077
Name:PORKOLAB, FREDERICK L (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:L
Last Name:PORKOLAB
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 1:2781 LEECHBURG RD
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068
Mailing Address - Country:US
Mailing Address - Phone:724-226-3345
Mailing Address - Fax:724-226-2415
Practice Address - Street 1:4727 FRIENDSHIP AVE
Practice Address - Street 2:STE 180
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1779
Practice Address - Country:US
Practice Address - Phone:412-235-5881
Practice Address - Fax:412-235-5878
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016838E207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006875420Medicaid
PA0006875420002Medicaid
WV0085813000Medicaid
PA0006875420007Medicaid
OH0639027Medicaid
PA060133GXEMedicare PIN
PAB34612Medicare UPIN
PA060133YBOTMedicare PIN
OH0639027Medicaid
PA0006875420Medicaid