Provider Demographics
NPI:1477739852
Name:BORUSZAK, ALLAN NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:NEAL
Last Name:BORUSZAK
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 1:4466 WILDRYE DR SE
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8683
Mailing Address - Country:US
Mailing Address - Phone:702-239-3131
Mailing Address - Fax:
Practice Address - Street 1:MCLEOD DILLON HOSPITAL
Practice Address - Street 2:301 E. JACSON ST
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536
Practice Address - Country:US
Practice Address - Phone:843-777-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400818207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137M4Medicaid
NC89137M4Medicaid
NC2032883AMedicare PIN
NC89137M4Medicaid