Provider Demographics
NPI:1679516850
Name:BORGIA, VICTORIA MARIE (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:BORGIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-4837
Mailing Address - Country:US
Mailing Address - Phone:267-809-1799
Mailing Address - Fax:215-274-0464
Practice Address - Street 1:1229 S 6TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-4837
Practice Address - Country:US
Practice Address - Phone:215-792-4212
Practice Address - Fax:215-274-0464
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69904207Q00000X
NJ25MA10208700207Q00000X
PAMD427968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101489641Medicaid
I49701Medicare UPIN
PA101489641Medicaid