Healthcare Provider Details

I. General information

NPI: 1457643637
Provider Name (Legal Business Name): BRYAN DAVID BORLAND DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W BROAD ST STE 200
COLUMBUS OH
43222-1478
US

IV. Provider business mailing address

815 W BROAD ST STE 200
COLUMBUS OH
43222-1478
US

V. Phone/Fax

Practice location:
  • Phone: 614-799-1906
  • Fax:
Mailing address:
  • Phone: 614-799-1906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.013478
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34.013478
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number34.013478
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: