Provider Demographics
NPI:1942255088
Name:BORMES, GREGORY WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WILLIAM
Last Name:BORMES
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:300B FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1257
Practice Address - Country:US
Practice Address - Phone:508-973-1020
Practice Address - Fax:508-973-1025
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-070187-L208200000X
MA265020208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017897430002Medicaid
PAH070042Medicare UPIN
PA0017897430002Medicaid