Healthcare Provider Details

I. General information

NPI: 1326811407
Provider Name (Legal Business Name): LAURIE BORGELLA PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

281 LINCOLN ST PROVIDER ENROLLMENT
WORCESTER MA
01605
US

V. Phone/Fax

Practice location:
  • Phone: 508-421-1401
  • Fax:
Mailing address:
  • Phone: 508-334-8015
  • Fax: 508-334-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: