Provider Demographics
NPI:1902911365
Name:ARIADNA L. BORY D.O. PA
Entity Type:Organization
Organization Name:ARIADNA L. BORY D.O. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIADNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-331-4500
Mailing Address - Street 1:2 STONERIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2725
Mailing Address - Country:US
Mailing Address - Phone:305-331-4500
Mailing Address - Fax:
Practice Address - Street 1:2010 BILL OWENS PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-6210
Practice Address - Country:US
Practice Address - Phone:903-247-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0059RJOtherBCBS TX
TX=========OtherEIN
TXI61893Medicare UPIN