Provider Demographics
NPI:1689603995
Name:PORTER, LAWRENCE MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MARTIN
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 1:5264 LEE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-1232
Mailing Address - Country:US
Mailing Address - Phone:216-294-4440
Mailing Address - Fax:216-249-6032
Practice Address - Street 1:5264 LEE RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-1232
Practice Address - Country:US
Practice Address - Phone:216-294-4440
Practice Address - Fax:216-249-6032
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-9239-P207P00000X
OH35.049239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0631329Medicaid
OHPO4048744Medicare PIN
OH0631329Medicaid
OHA16419Medicare UPIN