Provider Demographics
NPI:1689865214
Name:BORODYANSKY, LAURA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:BORODYANSKY
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 1:45 LONGWOOD AVE
Mailing Address - Street 2:#602
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5244
Mailing Address - Country:US
Mailing Address - Phone:617-840-7740
Mailing Address - Fax:
Practice Address - Street 1:45 LONGWOOD AVE
Practice Address - Street 2:#602
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5244
Practice Address - Country:US
Practice Address - Phone:617-840-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237697207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110080184AMedicaid
MA1689865214OtherBCBS OF MASSACHUSETTS
MA0046123OtherNEIGHBORHOOD HEALTH PLAN
MA953848-01OtherNETWORK HEALTH
MA1689865214OtherTUFTS HEALTH PLAN
MAAA121284OtherHARVARD PILGRIM
MA0046123OtherNEIGHBORHOOD HEALTH PLAN