Provider Demographics
NPI:1336199587
Name:BORRESEN, THOR ERIK (MD)
Entity type:Individual
Prefix:
First Name:THOR
Middle Name:ERIK
Last Name:BORRESEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6046
Mailing Address - Country:US
Mailing Address - Phone:704-334-7311
Mailing Address - Fax:704-335-9790
Practice Address - Street 1:1900 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6046
Practice Address - Country:US
Practice Address - Phone:704-334-7311
Practice Address - Fax:704-335-9790
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8917192Medicaid
2231570Medicare ID - Type Unspecified
NC8917192Medicaid