Provider Demographics
NPI:1104822170
Name:BORRILLO, DONATO J (MD)
Entity Type:Individual
Prefix:
First Name:DONATO
Middle Name:J
Last Name:BORRILLO
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 1:11100 AIRPORT HWY
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-9374
Mailing Address - Country:US
Mailing Address - Phone:419-466-5512
Mailing Address - Fax:419-710-7035
Practice Address - Street 1:615 JOHNNIE DODDS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3082
Practice Address - Country:US
Practice Address - Phone:843-936-6451
Practice Address - Fax:843-936-6451
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40559207Q00000X
OH350621532083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000212144OtherANTHEM COMMERICAL
OH840000277OtherOHIO RAILROAD MEDICARE
OH000000212144OtherANTHEM MEDICAID
MI0847454OtherMI MEDICAID
OH0847454Medicaid
OHBO7293811Medicare ID - Type UnspecifiedMEDICARE
OH840000277OtherOHIO RAILROAD MEDICARE