Provider Demographics
NPI:1730293358
Name:BORBOLI-GEROGIANNIS, SHEILA (MD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:BORBOLI-GEROGIANNIS
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 1:243 CHARLES STREET
Mailing Address - Street 2:MASSACHUSETTS EYE & EAR INFIRMARY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-523-7900
Mailing Address - Fax:617-573-3152
Practice Address - Street 1:243 CHARLES STREET
Practice Address - Street 2:MASSACHUSETTS EYE & EAR INFIRMARY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-523-7900
Practice Address - Fax:617-573-3152
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236736207W00000X
MS18152207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04771864Medicaid
MS180000359Medicare ID - Type Unspecified
H99516Medicare UPIN