Mary Therese Porta, PA-C
Physician Assistant in Troy, MI. Individual provider (NPI-1).
NPI number1174783005
StatusActive
Last updated in NPPESJul 28, 2022
Details
- NPI
- 1174783005
- Entity type
- Individual (NPI-1)
- Name
- Mary Therese Porta
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 13, 2008
- Certification date
- Jul 28, 2022
- Last updated
- Jul 28, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 5601005244 | MI | Yes |
Other names
- Mary Therese Green (Former Name)
Practice location
44201 Dequindre RdSuite Ec
Troy, MI 48085-1117
Phone 248-964-5111 · Fax 248-964-5068
Mailing address
26901 Beaumont Blvd Ste 3dSouthfield, MI 48033-3849
Phone 947-522-1865 · Fax 947-522-0307
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