Provider Demographics
NPI:1225449051
Name:BORLAND, TAD JUSTIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:TAD
Middle Name:JUSTIN
Last Name:BORLAND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-2412
Mailing Address - Country:US
Mailing Address - Phone:724-266-3180
Mailing Address - Fax:
Practice Address - Street 1:510 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:AMBRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15003-2412
Practice Address - Country:US
Practice Address - Phone:724-266-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006808213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery