Provider Demographics
NPI:1073521829
Name:BORTH, DEAN W (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:W
Last Name:BORTH
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 1:2600 6TH ST SW
Mailing Address - Street 2:AULTMAN HOSPITAL
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1702
Mailing Address - Country:US
Mailing Address - Phone:330-452-9911
Mailing Address - Fax:
Practice Address - Street 1:2600 TUSCARAWAS ST W STE 600
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4676
Practice Address - Country:US
Practice Address - Phone:330-453-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043543208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0668648Medicaid
B07214451Medicare ID - Type Unspecified
OH0668648Medicaid