MEDICARE: MARIA V BORODATCHEVA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0065651	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003027483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA V BORODATCHEVA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 418953
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-8953
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9396D BALTIMORE NATIONAL PIKE
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2802
Country	:	US
Telephone Number	:	410-480-9110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	04/05/2018

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