Provider Demographics
NPI:1922396035
Name:BORUE, XENIA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:XENIA
Middle Name:
Last Name:BORUE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EASTERN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-3038
Mailing Address - Country:US
Mailing Address - Phone:412-345-1159
Mailing Address - Fax:877-992-4235
Practice Address - Street 1:12 EASTERN AVE STE 200
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-3038
Practice Address - Country:US
Practice Address - Phone:412-345-1159
Practice Address - Fax:877-992-4235
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4501852084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030834200001Medicaid