Provider Demographics
NPI:1982601522
Name:BORDEN, DENISE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:LOUISE
Last Name:BORDEN
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 1:417 N 11TH ST
Mailing Address - Street 2:BOX 980447
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0447
Mailing Address - Country:US
Mailing Address - Phone:804-828-8786
Mailing Address - Fax:804-828-5466
Practice Address - Street 1:417 N 11TH ST
Practice Address - Street 2:BOX 980447
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0447
Practice Address - Country:US
Practice Address - Phone:804-828-8786
Practice Address - Fax:804-828-5466
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA322108OtherINDIVIDUAL BLUE SHIELD ID
VA005863902Medicaid
VA110228061OtherRAILROAD MEDICARE PROVIDE
VA110228061OtherRAILROAD MEDICARE PROVIDE
VA005863902Medicaid