Healthcare Provider Details

I. General information

NPI: 1831174010
Provider Name (Legal Business Name): AARON DAVID BORNSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LAKEVILLE BUSINESS PARK
LAKEVILLE MA
02347-1236
US

IV. Provider business mailing address

31 WALDEN DR
SOUTH EASTON MA
02375-1339
US

V. Phone/Fax

Practice location:
  • Phone: 508-947-0630
  • Fax: 508-947-0639
Mailing address:
  • Phone: 508-238-0531
  • Fax: 508-947-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224782
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: