Provider Demographics
NPI:1891716940
Name:BORJA, BENEDICTO R (MD)
Entity Type:Individual
Prefix:
First Name:BENEDICTO
Middle Name:R
Last Name:BORJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 L ST NW STE 600
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1540
Mailing Address - Country:US
Mailing Address - Phone:202-741-2900
Mailing Address - Fax:202-741-2891
Practice Address - Street 1:2120 L ST NW STE 600
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1540
Practice Address - Country:US
Practice Address - Phone:202-741-2900
Practice Address - Fax:202-741-2891
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406988900Medicaid
MDH36249Medicare UPIN
MD406988900Medicaid