Provider Demographics
NPI:1275505141
Name:BORN, MICHAEL WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:BORN
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 1:2295 SOUTH GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403
Mailing Address - Country:US
Mailing Address - Phone:717-741-9599
Mailing Address - Fax:717-741-0420
Practice Address - Street 1:2295 SOUTH GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403
Practice Address - Country:US
Practice Address - Phone:717-741-9599
Practice Address - Fax:717-741-0420
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033339E208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA742753OtherBLUE SHIELD
PA20009842OtherAMERIHEALTH MERCY
PA742753OtherKEYSTONE
PA001164812004Medicaid
01873201OtherCAPITOL BLUE CROSS
PA240006830OtherRAILROAD MEDICARE
P018712A002OtherCHAMPUS
PA1523691OtherGATEWAY
PA742753OtherKEYSTONE
01873201OtherCAPITOL BLUE CROSS