Provider Demographics
NPI:1215248695
Name:BORG, CHRISTOFER D (CMD, RT(T))
Entity type:Individual
Prefix:
First Name:CHRISTOFER
Middle Name:D
Last Name:BORG
Suffix:
Gender:M
Credentials:CMD, RT(T)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S SNOQUALMIE ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1740
Mailing Address - Country:US
Mailing Address - Phone:206-368-0579
Mailing Address - Fax:
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-768-5356
Practice Address - Fax:206-768-5331
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WART00004050247100000X, 2471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
330733OtherAMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGISTS
1474862OtherMEDICAL DOSIMETRIST CERTIFICATION BOARD