Provider Demographics
NPI:1053371609
Name:BORHANIAN, KAMRAN (MD)
Entity type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:
Last Name:BORHANIAN
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 1:200 S. HERLONG AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-6548
Mailing Address - Country:US
Mailing Address - Phone:803-909-6300
Mailing Address - Fax:803-909-6310
Practice Address - Street 1:200 S. HERLONG AVE.
Practice Address - Street 2:SUITE G
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1182
Practice Address - Country:US
Practice Address - Phone:803-909-6300
Practice Address - Fax:803-909-6310
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12626208600000X
NC122154208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC126269Medicaid
NC122154OtherLICENSE NUMBER
NC890509XMedicaid
NC122154OtherLICENSE NUMBER
B91467Medicare UPIN