Provider Demographics
NPI:1023125861
Name:BORJA, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
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 1:2117 SIMONTON RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8206
Mailing Address - Country:US
Mailing Address - Phone:704-871-2323
Mailing Address - Fax:803-619-2149
Practice Address - Street 1:2117 SIMONTON RD
Practice Address - Street 2:SUITE 402
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-8206
Practice Address - Country:US
Practice Address - Phone:704-871-2323
Practice Address - Fax:803-619-2149
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NC9601146208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3217120OtherAETNA HMO
NC891002PMedicaid
NC1002POtherBCBS OF NC
NC7904102OtherAETNA PPO
NC1002POtherBCBS OF NC
NC7904102OtherAETNA PPO