Provider Demographics
NPI:1508178377
Name:BORA, VAIBHAV (MBBS)
Entity Type:Individual
Prefix:DR
First Name:VAIBHAV
Middle Name:
Last Name:BORA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 CHESTER AVE
Mailing Address - Street 2:APT 429
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1617
Mailing Address - Country:US
Mailing Address - Phone:585-319-9912
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:AUGUSTA UNIVERSITY
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075143207LC0200X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine