Provider Demographics
NPI:1518062892
Name:BORTKO, MARGARET ANNE (FNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANNE
Last Name:BORTKO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1243
Mailing Address - Country:US
Mailing Address - Phone:410-479-4306
Mailing Address - Fax:410-479-1714
Practice Address - Street 1:609 DAFFIN LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1392
Practice Address - Country:US
Practice Address - Phone:410-479-2650
Practice Address - Fax:410-479-1626
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN014969363LF0000X
AK976363LF0000X
MDR205379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0435669Medicaid
MT000080684Medicare ID - Type Unspecified
MTS25436Medicare UPIN