Healthcare Provider Details

I. General information

NPI: 1700847498
Provider Name (Legal Business Name): TERESA P BORINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WESTWOOD DR SUITE A
HAMILTON MT
59840-2305
US

IV. Provider business mailing address

1201 WESTWOOD DR SUITE A
HAMILTON MT
59840-2305
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-3627
  • Fax: 406-363-3638
Mailing address:
  • Phone: 406-363-3627
  • Fax: 406-363-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8006
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: