Provider Demographics
NPI:1962494500
Name:BORDENICK, ROY MYRON (MS)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:MYRON
Last Name:BORDENICK
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 OLD PLANTATION WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6370
Mailing Address - Country:US
Mailing Address - Phone:410-484-1235
Mailing Address - Fax:410-668-1075
Practice Address - Street 1:7658A BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4088
Practice Address - Country:US
Practice Address - Phone:410-668-9198
Practice Address - Fax:410-668-1075
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD00126231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00061325OtherPALMETTO RR MEDICARE
MDP00061325OtherPALMETTO RR MEDICARE
MD089MMedicare ID - Type UnspecifiedAUDIOLOGIST