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: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date: 01/19/2022
Reactivation Date: 04/12/2023

III. Provider practice location address

1321 FIFTH AVENUE SUITE 1, MCKEESPORT INTERNAL MEDICINE SUITE 1
MCKEESPORT PA
15132
US

IV. Provider business mailing address

3600 FORBES AVENUE FORBES TOWER - PLAZA LEVEL SUITE 140
PITTSBURGH PA
15213
US

V. Phone/Fax

Practice location:
  • Phone: 412-664-2782
  • Fax:
Mailing address:
  • Phone: 412-919-7919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT220918
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: