Provider Demographics
NPI:1063596245
Name:BORN, TAGE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:TAGE
Middle Name:ELIZABETH
Last Name:BORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S PENN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401
Mailing Address - Country:US
Mailing Address - Phone:605-225-1636
Mailing Address - Fax:605-229-2434
Practice Address - Street 1:310 S PENN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401
Practice Address - Country:US
Practice Address - Phone:605-225-1636
Practice Address - Fax:605-229-2434
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3807207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6200220Medicaid
SD6200220Medicaid
SD3463Medicare ID - Type Unspecified