MEDICARE: MARY D BORON CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	NP01401	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	27460006500	OTHER	OH	BWC

General Provider Information

NPI Number	:	1861417982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY D BORON CNP

Provider Business Mailing Address
First Line	:	4330 W 150TH ST
Second Line	:	METROHEALTH OUTPATIENT SURGERY CENTER
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1362
Country	:	US
Telephone Number	:	216-251-6990
Fax Number	:

Provider Business Practice Location Address
First Line	:	4330 W 150TH ST
Second Line	:	METROHEALTH OUTPATIENT SURGERY CENTER
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1362
Country	:	US
Telephone Number	:	216-251-6990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/20/2009

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