Provider Demographics
NPI:1982861290
Name:BORRERO, MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:BORRERO
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 1:6060 RIDGE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1659
Mailing Address - Country:US
Mailing Address - Phone:718-294-6200
Mailing Address - Fax:718-294-6259
Practice Address - Street 1:2024 CRESTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4244
Practice Address - Country:US
Practice Address - Phone:718-294-6200
Practice Address - Fax:718-294-6259
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine