Provider Demographics
NPI:1518691021
Name:BORGER, JUDITH ANNE
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:BORGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 DAY BEACON DR
Mailing Address - Street 2:
Mailing Address - City:BELHAVEN
Mailing Address - State:NC
Mailing Address - Zip Code:27810-1491
Mailing Address - Country:US
Mailing Address - Phone:919-606-2634
Mailing Address - Fax:
Practice Address - Street 1:203 EARNHART DR STE A
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-8401
Practice Address - Country:US
Practice Address - Phone:252-482-7407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12578363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant