Healthcare Provider Details

I. General information

NPI: 1952861684
Provider Name (Legal Business Name): LUIS J. BORDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 09/15/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 BULIFANTS BLVD STE C
WILLIAMSBURG VA
23188-5732
US

IV. Provider business mailing address

150 KINGS MANOR DR APT 9428
WILLIAMSBURG VA
23185-3080
US

V. Phone/Fax

Practice location:
  • Phone: 757-622-6315
  • Fax: 757-622-7022
Mailing address:
  • Phone: 786-327-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101288125
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number0101288125
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: