Healthcare Provider Details

I. General information

NPI: 1366726358
Provider Name (Legal Business Name): NARCISO A DE BORJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 REISTERSTOWN RD FL 1
BALTIMORE MD
21215-2686
US

IV. Provider business mailing address

406 CHAPELWOOD LN
LUTHERVILLE MD
21093-2816
US

V. Phone/Fax

Practice location:
  • Phone: 410-486-2298
  • Fax: 410-358-6551
Mailing address:
  • Phone: 410-252-6334
  • Fax: 410-467-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberD0014870
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberDOO14870
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0014870
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: