Provider Demographics
NPI:1972650778
Name:BORKON, MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BORKON
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 1:1880 AMHERST STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2873
Mailing Address - Country:US
Mailing Address - Phone:540-536-6721
Mailing Address - Fax:540-536-6724
Practice Address - Street 1:1880 AMHERST ST STE 300
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-6721
Practice Address - Fax:540-536-6724
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27458208600000X
TN438062086S0129X
VA01012602752086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ001232Medicaid
103I779572Medicare PIN