Provider Demographics
NPI:1568496313
Name:BORKOWSKI, TERESA A (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:BORKOWSKI
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 1:133 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3904
Mailing Address - Country:US
Mailing Address - Phone:617-421-1300
Mailing Address - Fax:617-421-1362
Practice Address - Street 1:133 BROOKLINE AVENUE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-1300
Practice Address - Fax:617-421-1362
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA71425207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0118231Medicaid
MA0118231Medicaid