Provider Demographics
NPI:1518920057
Name:BOREN, MARY N (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:N
Last Name:BOREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 REEDSDALE STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15233
Mailing Address - Country:US
Mailing Address - Phone:412-323-4543
Mailing Address - Fax:412-323-4507
Practice Address - Street 1:1200 REEDSDALE STREET
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15233
Practice Address - Country:US
Practice Address - Phone:412-323-4543
Practice Address - Fax:412-323-4507
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039860E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1783125OtherHIGHMARK
PA1015307750001Medicaid
PA098698Medicare ID - Type Unspecified
PA1015307750001Medicaid