Provider Demographics
NPI:1649545500
Name:BORGES, TIMOTHY (COTA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BORGES
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 THURBERS AVE
Mailing Address - Street 2:220A
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4754
Mailing Address - Country:US
Mailing Address - Phone:401-270-9991
Mailing Address - Fax:401-270-2839
Practice Address - Street 1:134 THURBERS AVE
Practice Address - Street 2:220A
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4754
Practice Address - Country:US
Practice Address - Phone:401-270-9991
Practice Address - Fax:401-270-2839
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI224Z00000X174400000X
RIOTA00549174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist