Individual
DR. JACQUELINE TOBY BORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
725 W LOMBARD ST, BALTIMORE, MD 21201-1009
(410) 706-5651
(410) 706-4619
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4442
(410) 706-5651
(410) 706-4619
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
255522
NY
207RI0200X
Infectious Disease Physician
Primary
D77174
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
902504900
—
MD
01
—
S062-0553
CAREFIRST BC/BS
MD
Enumeration date
06/07/2008
Last updated
10/10/2014
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