Provider Demographics
NPI:1093295008
Name:BORGE, JOSEPH (PH238304)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:BORGE
Suffix:
Gender:M
Credentials:PH238304
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3330
Mailing Address - Country:US
Mailing Address - Phone:978-290-3101
Mailing Address - Fax:
Practice Address - Street 1:127 EASTERN AVE # 135
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1802
Practice Address - Country:US
Practice Address - Phone:978-281-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH238304OtherPHARMACY LICENSE