Provider Demographics
NPI:1063594307
Name:BORS, KATHLEEN P (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:P
Last Name:BORS
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7000
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-7000
Mailing Address - Country:US
Mailing Address - Phone:304-347-1290
Mailing Address - Fax:304-347-1397
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-4600
Practice Address - Fax:304-388-4603
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV16039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0052666000Medicaid
E67597Medicare UPIN
E67597Medicare UPIN