Provider Demographics
NPI:1265476857
Name:BORRELLO, MICHAEL T (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:BORRELLO
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 1:356 MOUNTAIN VIEW DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446
Mailing Address - Country:US
Mailing Address - Phone:802-655-9798
Mailing Address - Fax:802-655-0002
Practice Address - Street 1:356 MOUNTAIN VIEW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5985
Practice Address - Country:US
Practice Address - Phone:802-655-9798
Practice Address - Fax:802-655-0002
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT042-0008720207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2342Medicaid
VTF69855Medicare UPIN
VT0VN2342Medicaid