Provider Demographics
NPI:1336251834
Name:BORDEN, JONATHAN A (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:A
Last Name:BORDEN
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 1:3533 SOUTHERN BLVD STE 3000
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1280
Mailing Address - Country:US
Mailing Address - Phone:937-299-8242
Mailing Address - Fax:937-299-8245
Practice Address - Street 1:3533 SOUTHERN BLVD STE 3000
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1280
Practice Address - Country:US
Practice Address - Phone:937-299-8242
Practice Address - Fax:937-299-8245
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-085227207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
06-00545OtherUNITED HEALTHCARE
000000342977OtherANTHEM
OHH384364OtherOH MEDCIARE
OH2330374Medicaid
5816074OtherAETNA
3482179OtherCIGNA
KY64095482Medicaid
OHQ00313811OtherRR MEDICARE
000000342977OtherANTHEM
G05236Medicare UPIN