Provider Demographics
NPI:1174546394
Name:BORKAN, THEODORE G (PHD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:G
Last Name:BORKAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 E BROAD ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2066
Mailing Address - Country:US
Mailing Address - Phone:614-231-9495
Mailing Address - Fax:
Practice Address - Street 1:3140 E BROAD ST
Practice Address - Street 2:SUITE #101
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2066
Practice Address - Country:US
Practice Address - Phone:614-231-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical