Provider Demographics
NPI:1396795761
Name:BORDER, MICHAEL W (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:W
Last Name:BORDER
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 1:20 SOUTHBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-5235
Mailing Address - Country:US
Mailing Address - Phone:508-765-9068
Mailing Address - Fax:508-765-0249
Practice Address - Street 1:20 SOUTHBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-5235
Practice Address - Country:US
Practice Address - Phone:508-765-9068
Practice Address - Fax:508-765-0249
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54489207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3099237Medicaid
MAJ13674OtherBLUE SHIELD
MAJ13674Medicare ID - Type Unspecified
MA3099237Medicaid