MEDICARE: DR. JOHN S BOORNAZIAN 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	7041	NH

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	:	1578561908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN S BOORNAZIAN M.D.

Provider Business Mailing Address
First Line	:	240 S MAIN ST
Second Line	:
City	:	WOLFEBORO
State	:	NH
Zip	:	03894-4411
Country	:	US
Telephone Number	:	603-569-6994
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 S MAIN ST
Second Line	:
City	:	WOLFEBORO
State	:	NH
Zip	:	03894-4411
Country	:	US
Telephone Number	:	603-569-7500
Fax Number	:

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

Provider Enumeration Date	:	07/10/2005
Last Update Date	:	03/12/2025

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