Provider Demographics
NPI:1871637520
Name:DR. GREGORY W. BORMES M.D.P.C.
Entity type:Organization
Organization Name:DR. GREGORY W. BORMES M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BORMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-346-7641
Mailing Address - Street 1:321 SPRUCE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1400
Mailing Address - Country:US
Mailing Address - Phone:570-346-7641
Mailing Address - Fax:570-344-5361
Practice Address - Street 1:321 SPRUCE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1400
Practice Address - Country:US
Practice Address - Phone:570-346-7641
Practice Address - Fax:570-344-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017897430003Medicaid
PA1936698OtherBCBS
PA1936698OtherBCBS