Provider Demographics
NPI:1487124723
Name:MARK A BORLAND
Entity type:Organization
Organization Name:MARK A BORLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BORLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-722-7467
Mailing Address - Street 1:6911 WATER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-2005
Mailing Address - Country:US
Mailing Address - Phone:814-722-7467
Mailing Address - Fax:814-836-8194
Practice Address - Street 1:1738 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-5024
Practice Address - Country:US
Practice Address - Phone:814-722-7467
Practice Address - Fax:814-836-8194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA$$$$$$$$$OtherSOCIAL SECURITY
PA1029517440001OtherPROMISE ID
PA1295145795OtherNPI
PA12686599OtherCAQH