Provider Demographics
NPI:1336130798
Name:BORROMEO, DOUGLAS B (MD,)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:B
Last Name:BORROMEO
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 1:202 N BARRY ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2723
Mailing Address - Country:US
Mailing Address - Phone:716-372-0223
Mailing Address - Fax:716-373-7191
Practice Address - Street 1:515 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1513
Practice Address - Country:US
Practice Address - Phone:716-372-0223
Practice Address - Fax:716-373-7191
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141589-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00558154Medicaid
NY00558154Medicaid
NYF34201Medicare ID - Type Unspecified