Active NPI
Anthony Michael Borcich, LMT, LMP
- Specialist
- Portland, OR
National Provider Identifier
1306088075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 11005
- Practice address
- 4805 NE Glisan St
First Floor North Tower
Portland, OR 97213-2933 - Phone
- (503) 215-3219
- Fax
- (503) 215-7572
- NPI assigned
- Mar 27, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 11005 | OR | Primary |
| Specialist | 174400000X | MA00019710 | WA |
Addresses
Primary practice location
4805 NE Glisan St
First Floor North Tower
Portland, OR 97213-2933
Mailing address
4805 NE Glisan St
First Floor North Tower
Portland, OR 97213-2933
Phone (503) 215-3219
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00019710 | WA | MD | Specialist |
| 11005 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238371200000",
"number": "1306088075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4805 NE GLISAN ST",
"address_2": "FIRST FLOOR NORTH TOWER",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972132933",
"telephone_number": "503-215-3219",
"fax_number": "503-215-7572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4805 NE GLISAN ST",
"address_2": "FIRST FLOOR NORTH TOWER",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972132933",
"telephone_number": "503-215-3219",
"fax_number": "503-215-7572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORCICH",
"first_name": "ANTHONY",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "LMT, LMP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-03-27",
"last_updated": "2009-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "11005",
"primary": true
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA00019710",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.