Provider Demographics
NPI:1235106378
Name:BORGMAN, JODY (MD)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:BORGMAN
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 1:5501 OLD YORK RD
Mailing Address - Street 2:KLEIN, 363
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-6948
Mailing Address - Fax:215-455-1933
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:KLEIN, 363
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-6948
Practice Address - Fax:215-455-1933
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045369L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012820200002Medicaid
F34059Medicare UPIN
PA720236Medicare PIN