Provider Demographics
NPI:1386637833
Name:BORCHARDT, ROGER L (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:L
Last Name:BORCHARDT
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 1:144 S 500 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1907
Mailing Address - Country:US
Mailing Address - Phone:801-463-7415
Mailing Address - Fax:801-463-7341
Practice Address - Street 1:3000 N TRIUMPH BLVD, STE 330
Practice Address - Street 2:WASATCH CARDIOVASCULAR SERVICES
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4999
Practice Address - Country:US
Practice Address - Phone:801-753-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5123441205207RC0000X
NJ25MA08749100207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F31206Medicare UPIN
UT005701422Medicare PIN