1326043886 NPI number — DR. LAWRENCE S BOROW M.D.

Table of content: DR. LAWRENCE S BOROW M.D. (NPI 1326043886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326043886 NPI number — DR. LAWRENCE S BOROW M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOROW
Provider First Name:
LAWRENCE
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1326043886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
146 MONTGOMERY AVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
BALA CYNWYD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19004-2956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-668-1170
Provider Business Mailing Address Fax Number:
610-668-7922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
146 MONTGOMERY AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
BALA CYNWYD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19004-2956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-668-1170
Provider Business Practice Location Address Fax Number:
610-668-7922
Provider Enumeration Date:
06/20/2005

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: 174400000X , with the licence number:  MD012802E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MD012802E . This is a "PA MEDICAL LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 158729 . This is a "BLUE SHIELD OF PA." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 32005 . This is a "AETNA HEALTH INSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0045404000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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