Healthcare Provider Details

I. General information

NPI: 1174540173
Provider Name (Legal Business Name): SAMUEL R BORSELLINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 KOLBE RD STE 100
LORAIN OH
44053-1652
US

IV. Provider business mailing address

3600 KOLBE RD STE 100
LORAIN OH
44053-1652
US

V. Phone/Fax

Practice location:
  • Phone: 440-930-6015
  • Fax: 440-930-6094
Mailing address:
  • Phone: 440-930-6015
  • Fax: 440-930-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2016-02431
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2016-02431
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: