Provider Demographics
NPI:1205888294
Name:BORGMAN, AMY S (PA)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:S
Last Name:BORGMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6092 VERMONT ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05036-9695
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4239
Practice Address - Country:US
Practice Address - Phone:802-476-6696
Practice Address - Fax:802-476-6419
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550030098363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000223Medicaid
VTAP0870Medicare ID - Type UnspecifiedMEDICARE
VT9000223Medicaid