Provider Demographics
NPI:1174519888
Name:BORZOTTA, ANTHONY P (MD)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:P
Last Name:BORZOTTA
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 1:2555 COURT DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2134
Mailing Address - Country:US
Mailing Address - Phone:704-671-7652
Mailing Address - Fax:704-671-7656
Practice Address - Street 1:2555 COURT DR
Practice Address - Street 2:SUITE 450
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2134
Practice Address - Country:US
Practice Address - Phone:704-671-7652
Practice Address - Fax:704-671-7656
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0528362086S0127X
NC2012-017902086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2258113Medicaid
NC5921841Medicaid
NC5921841Medicaid
OHA08117Medicare UPIN
NCNC8977AMedicare PIN
OH4051932Medicare PIN
OH4051933Medicare PIN