Healthcare Provider Details

I. General information

NPI: 1063594307
Provider Name (Legal Business Name): KATHLEEN P BORS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE 5TH FLOOR
CHARLESTON WV
25304-1227
US

IV. Provider business mailing address

PO BOX 7000
MORGANTOWN WV
26507-7000
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-4600
  • Fax: 304-388-4603
Mailing address:
  • Phone: 304-347-1290
  • Fax: 304-347-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16039
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: