Healthcare Provider Details

I. General information

NPI: 1871637520
Provider Name (Legal Business Name): DR. GREGORY W. BORMES M.D.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 SPRUCE ST SUITE 200
SCRANTON PA
18503-1400
US

IV. Provider business mailing address

321 SPRUCE ST SUITE 200
SCRANTON PA
18503-1400
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-7641
  • Fax: 570-344-5361
Mailing address:
  • Phone: 570-346-7641
  • Fax: 570-344-5361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0017897430003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1936698
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBCBS

VIII. Authorized Official

Name: DR. GREGORY W BORMES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 570-346-7641