1619949310 NPI number — DR. OCTAVIO A BORGES MD

Table of content: DR. OCTAVIO A BORGES MD (NPI 1619949310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619949310 NPI number — DR. OCTAVIO A BORGES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORGES
Provider First Name:
OCTAVIO
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619949310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ROUTE 12 BLDG 449
Provider Second Line Business Mailing Address:
ATTN PROFESSIONAL AFFAIRS
Provider Business Mailing Address City Name:
GROTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06349-5600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-694-2377
Provider Business Mailing Address Fax Number:
860-694-2590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 SMITH RD
Provider Second Line Business Practice Location Address:
NAVAL HEALTH CARE NEW ENGLAND NEWPORT
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02841-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-694-2377
Provider Business Practice Location Address Fax Number:
860-694-3590
Provider Enumeration Date:
02/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  159418 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)