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Organization
AVELLA FAMILY PRACTICE,LLC
Active
Organization
AVELLA FAMILY PRACTICE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SEAN MATTHEW PORBIN M.D. (OWNER)
(724) 587-3472
Entity
Organization
Contact information
Practice address
9 CAMPBELL DR, BOX 187, AVELLA, PA 15312-2738
(724) 587-3472
(724) 587-5947
Mailing address
1394 AVELLA RD, AVELLA, PA 15312-3302
(724) 587-0296
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD063186L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011626600001
—
PA
Enumeration date
10/24/2006
Last updated
07/15/2010
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