Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D0065651 | MD |
Y | 111NI0900X | Internist | D0065651 | MD |
NPI | 1003027483 |
---|---|
Provider Name | Maria V Borodatcheva |
First Address | Boston, MA 02241-8953 |
Second Address | Ellicott City, MD 21042-2802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 05/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
412670000 | (05) | MD |