Provider Demographics
NPI:1417922238
Name:BOROSKY, BERNARD D (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:D
Last Name:BOROSKY
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 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7718
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:406 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-1542
Practice Address - Country:US
Practice Address - Phone:256-386-7100
Practice Address - Fax:256-386-0937
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL198632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL152195Medicaid
AL631225938OtherAETNA
AL009901025Medicaid
AL511-33650OtherBLUE CROSS
AL515-07181OtherBCBS
AL152195Medicaid
AL000009460Medicare PIN
AL009901025Medicaid
AL510I300039Medicare PIN