Healthcare Provider Details

I. General information

NPI: 1942170147
Provider Name (Legal Business Name): MATTHEW LIAM BORODITSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

1661 ONTARIO ST 902
VANCOUVER BC
V5Y 0C3
CA

V. Phone/Fax

Practice location:
  • Phone: 617-724-5058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number46149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: