Provider Demographics
NPI:1174550701
Name:BORDON, JOSE (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:BORDON
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 1:1140 VARNUM ST NE STE 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2153
Mailing Address - Country:US
Mailing Address - Phone:202-891-7872
Mailing Address - Fax:
Practice Address - Street 1:1140 VARNUM ST NE STE 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2153
Practice Address - Country:US
Practice Address - Phone:202-525-5175
Practice Address - Fax:202-450-6088
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-07-06
Deactivation Date:2022-01-31
Deactivation Code:
Reactivation Date:2022-02-14
Provider Licenses
StateLicense IDTaxonomies
DCMD33630207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease