Provider Demographics
NPI:1245276658
Name:BORCHERT, CHRISTOPHER ALAN (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:BORCHERT
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 1:29 HOSPITAL PLZ
Mailing Address - Street 2:SUITE F
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-8470
Mailing Address - Country:US
Mailing Address - Phone:304-269-1071
Mailing Address - Fax:304-269-1074
Practice Address - Street 1:29 HOSPITAL PLZ
Practice Address - Street 2:SUITE F
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8470
Practice Address - Country:US
Practice Address - Phone:304-269-1071
Practice Address - Fax:304-269-1074
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14876174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV14876OtherTHE HEALTH PLAN
WV0106524000Medicaid
WV0106524000Medicaid
WVWV14876OtherTHE HEALTH PLAN