Healthcare Provider Details

I. General information

NPI: 1700861655
Provider Name (Legal Business Name): MARTHA BORGES WAITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA FRANCES BORGES

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BOYDEN RD
HOLDEN MA
01520
US

IV. Provider business mailing address

630 PLANTATION ST
WORCESTER MA
01605-2038
US

V. Phone/Fax

Practice location:
  • Phone: 508-885-2003
  • Fax: 508-885-8071
Mailing address:
  • Phone: 508-885-2003
  • Fax: 508-885-8071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number73863
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: