Provider Demographics
NPI:1982997839
Name:BORDONARO, BARRY LAWRENCE (MD)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:LAWRENCE
Last Name:BORDONARO
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 1:4336 NORTH BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3920
Mailing Address - Country:US
Mailing Address - Phone:225-379-3519
Mailing Address - Fax:225-379-3522
Practice Address - Street 1:4336 NORTH BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3920
Practice Address - Country:US
Practice Address - Phone:225-379-3519
Practice Address - Fax:225-379-3522
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.018171208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice