Provider Demographics
NPI:1477644805
Name:BORUCHOV, DONNA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:BORUCHOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:282 WASHINGTON ST
Mailing Address - Street 2:SUITE 5A - CENTER FOR CANCER & BLOOD DISORDERS
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-545-9630
Mailing Address - Fax:860-545-9622
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:SUITE 5A - CENTER FOR CANCER & BLOOD DISORDERS
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-545-9630
Practice Address - Fax:860-545-9622
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2120982080P0207X
CT0467272080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02581708Medicaid
NY02581708Medicaid
NY603X01Medicare ID - Type Unspecified