Provider Demographics
NPI:1184735052
Name:BORTS, FREDERICK T (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:T
Last Name:BORTS
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 1:903 ROBBINS AVENUE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446
Mailing Address - Country:US
Mailing Address - Phone:330-505-1225
Mailing Address - Fax:
Practice Address - Street 1:32 JEFFERSON AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3354
Practice Address - Country:US
Practice Address - Phone:714-981-6732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD66462085R0202X
CAG683102085R0202X
PAMD-031970E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIE52933Medicare UPIN