Provider Demographics
NPI:1619949310
Name:BORGES, OCTAVIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:OCTAVIO
Middle Name:A
Last Name:BORGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:ROUTE 12 BLDG 449
Mailing Address - Street 2:ATTN PROFESSIONAL AFFAIRS
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5600
Mailing Address - Country:US
Mailing Address - Phone:860-694-2377
Mailing Address - Fax:860-694-2590
Practice Address - Street 1:43 SMITH RD
Practice Address - Street 2:NAVAL HEALTH CARE NEW ENGLAND NEWPORT
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841-1002
Practice Address - Country:US
Practice Address - Phone:860-694-2377
Practice Address - Fax:860-694-3590
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA159418207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN