Provider Demographics
NPI:1649201377
Name:BORYS A MASCARENHAS MD PA
Entity Type:Organization
Organization Name:BORYS A MASCARENHAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BORYS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASCARENHAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-742-2286
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:MT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32756
Mailing Address - Country:US
Mailing Address - Phone:352-742-2286
Mailing Address - Fax:352-742-2289
Practice Address - Street 1:1879 NIGHTINGALE LANE
Practice Address - Street 2:SUITE B4
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778
Practice Address - Country:US
Practice Address - Phone:352-742-2286
Practice Address - Fax:352-742-2289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85389208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17534Medicare ID - Type Unspecified
H63804Medicare UPIN