=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063851160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DURGA BORKAR M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2013
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 840 WALNUT ST STE 1020
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-5109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-331-6634
-----------------------------------------------------
Fax | 215-825-2443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4060 BUTLER PIKE STE 200
-----------------------------------------------------
City | PLYMOUTH MEETING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19462-1560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-331-6634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MD460186
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------