Basic Information
| Provider Information | |||||||||
| NPI: | 1396795761 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORDER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 SOUTHBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | CHARLTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015075235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087659068 | ||||||||
| FaxNumber: | 5087650249 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 SOUTHBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | CHARLTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015075235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087659068 | ||||||||
| FaxNumber: | 5087650249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 01/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 54489 | MA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 3099237 | 05 | MA | MEDICAID | J13674 | 01 | MA | BLUE SHIELD | OTHER |