Provider Demographics
NPI:1568571396
Name:BORDIUK, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BORDIUK
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 1:65 WALNUT ST
Mailing Address - Street 2:SUITE 380
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2118
Mailing Address - Country:US
Mailing Address - Phone:781-239-9900
Mailing Address - Fax:781-239-9953
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:SUITE 380
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2118
Practice Address - Country:US
Practice Address - Phone:781-239-9900
Practice Address - Fax:781-239-9953
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0406799OtherUNITED HEALTH CARE
MA692543OtherHARVARD PILGRIM
MAJ16668OtherBCBS
MAM21670OtherMEDICARE PROVIDER GROUP
MA7998387OtherCIGNA
MA792774OtherTUFTS HEALTH PLAN
MA5424600OtherAETNA
MA792774OtherTUFTS HEALTH PLAN