Provider Demographics
NPI:1033104435
Name:BORKOWSKI, LISA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BORKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 NEIL AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:614-464-3937
Mailing Address - Fax:614-464-0088
Practice Address - Street 1:262 NEIL AVE
Practice Address - Street 2:STE 220
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-464-3937
Practice Address - Fax:614-464-0088
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084761207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00147445OtherRAILROAD MEDICARE
OH2496768Medicaid
OH2496768Medicaid
BA4137201Medicare PIN
H07587Medicare UPIN
BA4137202Medicare PIN