Provider Demographics
NPI:1225240682
Name:BOBORODEA, VIOREL (MD)
Entity Type:Individual
Prefix:DR
First Name:VIOREL
Middle Name:
Last Name:BOBORODEA
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 1:12123 SHELBYVILLE RD, STE 100-PMB 265
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1079
Mailing Address - Country:US
Mailing Address - Phone:502-489-7740
Mailing Address - Fax:
Practice Address - Street 1:12123 SHELBYVILLE RD, STE 100 PMB 265
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243
Practice Address - Country:US
Practice Address - Phone:502-489-7740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29482207Q00000X, 207V00000X
NY180194207QA0505X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100059790Medicaid
NYWYQYY1Medicare PIN
KYK053356Medicare PIN
NY65F58YQYY1Medicare PIN
NY65F58YRPT1Medicare PIN
KY7100059790Medicaid
KYK05338Medicare PIN