Provider Demographics
NPI:1831114859
Name:BORO, DEIRDRE A (PA-C)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:A
Last Name:BORO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1699
Mailing Address - Country:US
Mailing Address - Phone:207-294-5600
Mailing Address - Fax:
Practice Address - Street 1:201 S MAIN ST
Practice Address - Street 2:SUITE 3100
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2927
Practice Address - Country:US
Practice Address - Phone:434-799-4490
Practice Address - Fax:434-773-6895
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1847363A00000X
VA01100017602085B0100X, 2085P0229X, 2085N0700X, 2085N0904X, 2085R0204X, 2085U0001X, 363AS0400X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ04717Medicare UPIN
DC013014F43Medicare PIN
DCP00136574Medicare PIN