Provider Demographics
NPI:1134115553
Name:BOREK, LEORA (MD)
Entity Type:Individual
Prefix:
First Name:LEORA
Middle Name:
Last Name:BOREK
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 1:115 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1064
Mailing Address - Country:US
Mailing Address - Phone:617-855-3124
Mailing Address - Fax:
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1064
Practice Address - Country:US
Practice Address - Phone:617-855-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11604174400000X
RI116042084P0800X
MA2383872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI412161OtherBLUE CHIP
ID050513332OtherUNITED BEHAVORIAL HEALTH
RI29171OtherBLUECROSS BLUESHIELD RI
RI369535OtherMHN
RIP00344436OtherRAILROAD MEDICARE
RI1134115553OtherNPI
RII22695Medicare UPIN
RI1134115553OtherNPI
RIP00344436OtherRAILROAD MEDICARE