Provider Demographics
NPI:1184685034
Name:BORAH, BISHNU CHARAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BISHNU
Middle Name:CHARAN
Last Name:BORAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:380 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE# 702
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1845
Mailing Address - Country:US
Mailing Address - Phone:215-752-9100
Mailing Address - Fax:215-752-4316
Practice Address - Street 1:380 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE# 702
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1845
Practice Address - Country:US
Practice Address - Phone:215-752-9100
Practice Address - Fax:215-752-4316
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023073E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006230800001Medicaid
PA0006230800001Medicaid