Healthcare Provider Details

I. General information

NPI: 1508484163
Provider Name (Legal Business Name): HETAL RAMESH BORICHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date: 01/19/2022
Reactivation Date: 04/12/2023

III. Provider practice location address

3903 N ELM ST STE 201
GREENSBORO NC
27455-2878
US

IV. Provider business mailing address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-878-6530
  • Fax: 336-878-6531
Mailing address:
  • Phone: 336-716-6674
  • Fax: 336-716-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT220918
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2026-02855
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: