Provider Demographics
NPI:1659654507
Name:BORGES, DEMETRIA L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DEMETRIA
Middle Name:L
Last Name:BORGES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEMETRIA
Other - Middle Name:J
Other - Last Name:LOUKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 791128
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279
Mailing Address - Country:US
Mailing Address - Phone:703-391-2030
Mailing Address - Fax:703-273-3943
Practice Address - Street 1:6201 CENTREVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121
Practice Address - Country:US
Practice Address - Phone:703-263-9600
Practice Address - Fax:703-266-1452
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003685363A00000X
MDC04590363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant