Individual
JEREMY S BORDEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD MPH
Contact information
Practice address
281 LINCOLN STREET, UMASS DERMATOLOGY HAHNEMANN CAMPUS, WORCESTER, MA 01605
(508) 334-5971
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
35-089926
OH
207ND0101X
MOHS-Micrographic Surgery Physician
228008
MA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
35-089926
OH
207NS0135X
Procedural Dermatology Physician
35-089926
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221131
UNISON
OH
01
—
000000524092
ANTHEM
OH
05
—
2771522
—
OH
01
—
414951
WELLCARE
OH
01
—
5569102
AETNA
OH
01
—
750496
BUCKEYE
OH
01
—
P00406576
RAILROAD MEDICARE
OH
Enumeration date
07/07/2006
Last updated
12/17/2020
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