Basic Information
Provider Information | |||||||||
NPI: | 1629078027 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BORGER | ||||||||
FirstName: | ANNETTE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1605 N CEDAR CREST BLVD STE 110B | ||||||||
Address2: |   | ||||||||
City: | ALLENTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 181042351 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6109731410 | ||||||||
FaxNumber: | 6109731449 | ||||||||
Practice Location | |||||||||
Address1: | 1310 ROUTE 209 STE 103 | ||||||||
Address2: |   | ||||||||
City: | GILBERT | ||||||||
State: | PA | ||||||||
PostalCode: | 183317751 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6109514500 | ||||||||
FaxNumber: | 6109514600 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/28/2005 | ||||||||
LastUpdateDate: | 08/31/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/31/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD068283L | PA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 208000000X | MD068283L | PA | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 207R00000X | MD068283L | PA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 002810 | 01 | PA | FIRST PRIORITY HEALTH | OTHER | 202991704 | 01 |   | HEALTH AMERICA | OTHER | 614574 | 01 |   | HIGHMARK | OTHER | 5092509 | 01 |   | AETNA | OTHER | 52157 | 01 |   | GEISINGER | OTHER | 20057837 | 01 | PA | AMERIHEALTH MERCY | OTHER | 0017584980003 | 05 | PA |   | MEDICAID | 50059317 | 01 |   | KEYSTONE CAPTIAL BC | OTHER |