Provider Demographics
NPI:1568456291
Name:BORODIC, GARY E (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:E
Last Name:BORODIC
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1261 FURNACE BROOK PKWY
Mailing Address - Street 2:SUITE 15
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4721
Mailing Address - Country:US
Mailing Address - Phone:617-770-0011
Mailing Address - Fax:617-770-0030
Practice Address - Street 1:1261 FURNACE BROOK PKWY
Practice Address - Street 2:SUITE 15
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4721
Practice Address - Country:US
Practice Address - Phone:617-770-0011
Practice Address - Fax:617-770-0030
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2016-05-12
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Provider Licenses
StateLicense IDTaxonomies
MA51271207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6171249Medicaid
MA6171249Medicaid
MAJ0218801Medicare PIN
B99146Medicare UPIN