Provider Demographics
NPI:1205954781
Name:BORNSTEIN, JOAN CAROL (DO)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:CAROL
Last Name:BORNSTEIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8387
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-8300
Mailing Address - Country:US
Mailing Address - Phone:970-949-1666
Mailing Address - Fax:
Practice Address - Street 1:40 NOTTINGHAM ROAD
Practice Address - Street 2:SUITE 203B
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620-8300
Practice Address - Country:US
Practice Address - Phone:970-949-1666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO366362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC441068Medicare ID - Type Unspecified
E31602Medicare UPIN