Provider Demographics
NPI:1437210754
Name:BORDE, MADHUSUDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHUSUDAN
Middle Name:
Last Name:BORDE
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 1:1460 N CAMINO ALTO STE 111
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2567
Mailing Address - Country:US
Mailing Address - Phone:707-557-3200
Mailing Address - Fax:707-557-3201
Practice Address - Street 1:1460 N CAMINO ALTO STE 111
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2567
Practice Address - Country:US
Practice Address - Phone:707-557-3200
Practice Address - Fax:707-557-3201
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35179207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A351790Medicaid
CA00A351790Medicare ID - Type Unspecified
CA00A351790Medicaid