Healthcare Provider Details

I. General information

NPI: 1750605259
Provider Name (Legal Business Name): CHRISTINA MARIE BORDEAU D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

242 GREEN ST STE 3
GARDNER MA
01440-1336
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2777
  • Fax:
Mailing address:
  • Phone: 978-630-6474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number267676
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number17681
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number032-0134138
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: