Provider Demographics
NPI:1548223514
Name:BORDEN, NEIL M (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:M
Last Name:BORDEN
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 1:111 COLCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-2700
Mailing Address - Fax:
Practice Address - Street 1:1760 E PECOS RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3201
Practice Address - Country:US
Practice Address - Phone:480-553-8999
Practice Address - Fax:480-553-8989
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ219042085R0202X
OH350856962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ164372Medicaid
OHBO7345301Medicare PIN
OH2545240Medicaid