Provider Demographics
NPI:1023018363
Name:BORICH, SHAWN M (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:BORICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 ROCKBRIDGE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 ROCKBRIDGE ST STE 103
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4333
Practice Address - Country:US
Practice Address - Phone:804-386-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234495207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA002090V021Medicare PIN
VA016709V67Medicare PIN
VA021556E98Medicare PIN
VAVAA102860Medicare PIN
VA1023018363Medicaid
SC323395Medicaid
VAH89227Medicare UPIN
VA010002222Medicaid
VA010002257Medicaid
VAVAA101192Medicare PIN
VA018440V01Medicare PIN
VA018501V20Medicare PIN
VA010002249Medicaid
SCAA49889326Medicare PIN
VA010029635Medicaid
VA3810016222Medicaid