Provider Demographics
NPI:1871579870
Name:BORCHELT, BRET DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:DAVID
Last Name:BORCHELT
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-9094
Mailing Address - Fax:
Practice Address - Street 1:4622 COUNTRY CLUB RD
Practice Address - Street 2:STE 180
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3770
Practice Address - Country:US
Practice Address - Phone:336-768-9535
Practice Address - Fax:336-768-4155
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000364208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127N1Medicaid
NC2280755Medicare ID - Type Unspecified
NC2280755Medicare PIN
F56725Medicare UPIN
NCNC9515AMedicare PIN