Provider Demographics
NPI:1811999212
Name:BOROUGHS, EILEEN Y (MD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:Y
Last Name:BOROUGHS
Suffix:
Gender:F
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:PO BOX 6159
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-6159
Mailing Address - Country:US
Mailing Address - Phone:423-684-8005
Mailing Address - Fax:423-648-8006
Practice Address - Street 1:3370 JENKINS RD
Practice Address - Street 2:INTERNAL MEDICINE EAST
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1189
Practice Address - Country:US
Practice Address - Phone:423-648-8005
Practice Address - Fax:423-648-8006
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39277207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3327500Medicaid
TN3327500Medicaid
I25345Medicare UPIN