Healthcare Provider Details

I. General information

NPI: 1326043886
Provider Name (Legal Business Name): LAWRENCE S BOROW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 MONTGOMERY AVE STE 200
BALA CYNWYD PA
19004-2956
US

IV. Provider business mailing address

146 MONTGOMERY AVE STE 200
BALA CYNWYD PA
19004-2956
US

V. Phone/Fax

Practice location:
  • Phone: 610-668-1170
  • Fax: 610-668-7922
Mailing address:
  • Phone: 610-668-1170
  • Fax: 610-668-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD012802E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: