Jeremy S Bordeaux, MD MPH
Dermatology, MOHS-Micrographic Surgery in Worcester, MA. Individual provider (NPI-1).
NPI number1043242589
StatusActive
Last updated in NPPESDec 17, 2020
Details
- NPI
- 1043242589
- Entity type
- Individual (NPI-1)
- Name
- Jeremy S Bordeaux
- Credential
- MD MPH
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 7, 2006
- Certification date
- Dec 17, 2020
- Last updated
- Dec 17, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207ND0101X | Dermatology, MOHS-Micrographic Surgery | 35-089926 | OH | Yes |
| 207N00000X | Dermatology | 35-089926 | OH | |
| 207ND0101X | Dermatology, MOHS-Micrographic Surgery | 228008 | MA | |
| 207NS0135X | Dermatology, Procedural Dermatology | 35-089926 | OH |
Practice location
281 Lincoln StreetUmass Dermatology Hahnemann Campus
Worcester, MA 01605
Phone 508-334-5971
Mailing address
24701 Euclid Ave3rd Floor
Euclid, OH 44117-1714
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