Individual
MR. IVAN BORISSOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2945
(443) 444-8000
Mailing address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2945
(443) 444-8000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C04854
MD
Other
Enumeration date
07/12/2012
Last updated
05/11/2020
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