Individual
DR. JON CARLO PORCIUNCULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2800 GODWIN BLVD FL 1, SUFFOLK, VA 23434-8038
(757) 934-4821
(757) 934-4276
Mailing address
2800 GODWIN BLVD FL 1, SUFFOLK, VA 23434-8038
(757) 934-4821
(757) 934-4276
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101248397
VA
207R00000X
Internal Medicine Physician
0116019118
VA
207R00000X
Internal Medicine Physician
33137
SC
208M00000X
Hospitalist Physician
0101248397
VA
208M00000X
Hospitalist Physician
33137
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33137
MEDICAL LICENSE
SC
05
—
331377
—
SC
Enumeration date
03/14/2008
Last updated
07/21/2021
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