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NPI Code Detail

MEDICARE: BRADFORD BORDEN MD

MEDICARE: BRADFORD BORDEN 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
1207PE0004XEmergency Medical Services (Emergency Medicine) Physician35057920BOH

General Provider Information

NPI Number : 1619930971
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADFORD BORDEN MD
Provider Business Mailing Address
First Line : 50 QUAIL RDG
Second Line :
City : BENTLEYVILLE
State : OH
Zip : 44022-3606
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12300 MCCRACKEN RD
Second Line :
City : GARFIELD HEIGHTS
State : OH
Zip : 44125-2914
Country : US
Telephone Number : 216-581-0500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2006
Last Update Date : 07/08/2007

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