MEDICARE: THOR ERIK BORRESEN MD

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	2084N0400X	Neurology Physician	1563	NC

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	:	1336199587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOR ERIK BORRESEN MD

Provider Business Mailing Address
First Line	:	1900 SCOTT AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-6046
Country	:	US
Telephone Number	:	704-334-7311
Fax Number	:	704-335-9790

Provider Business Practice Location Address
First Line	:	1900 SCOTT AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-6046
Country	:	US
Telephone Number	:	704-334-7311
Fax Number	:	704-335-9790

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	02/27/2015

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Directions to “ THOR ERIK BORRESEN MD” Practice Location

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