Provider Demographics
NPI:1063696581
Name:MADHUSUDAN BORDE M.D. INC.
Entity type:Organization
Organization Name:MADHUSUDAN BORDE M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHUSUDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-557-3200
Mailing Address - Street 1:1460 N CAMINO ALTO STE 111
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2567
Mailing Address - Country:US
Mailing Address - Phone:707-557-3200
Mailing Address - Fax:707-557-3201
Practice Address - Street 1:1460 N CAMINO ALTO STE 111
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2567
Practice Address - Country:US
Practice Address - Phone:707-557-3200
Practice Address - Fax:707-557-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE74699Medicare UPIN
CA00A351794Medicare PIN