Richard Justin Boruta, MD | |
1001 Blythe Blvd, Ste 500, Charlotte, NC 28203-5866 | |
(704) 373-1813 | |
Not Available |
Full Name | Richard Justin Boruta |
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Gender | Male |
Speciality | Pediatrics - Pediatric Cardiology |
Location | 1001 Blythe Blvd, Charlotte, North Carolina |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1043444722 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2080P0202X | Pediatrics - Pediatric Cardiology | 2015-00923 (North Carolina) | Primary |
Entity Name | The Moses H Cone Memorial Hospital Operating Corporation |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1356372064 PECOS PAC ID: 6204744600 Enrollment ID: O20031124000541 |
Entity Name | Carolinas Physicians Network Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1477878890 PECOS PAC ID: 3375449655 Enrollment ID: O20031219000455 |
Entity Name | Wakemed |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1194907717 PECOS PAC ID: 7315937612 Enrollment ID: O20040722000418 |
Mailing Address | Practice Location Address |
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Richard Justin Boruta, MD Po Box 19305, Charlotte, NC 28219-9305 Ph: () - | Richard Justin Boruta, MD 1001 Blythe Blvd, Ste 500, Charlotte, NC 28203-5866 Ph: (704) 373-1813 |
Kristina Jasmin Harrell, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1350 S Kings Dr, Charlotte, NC 28207 Phone: 704-446-1422 | |
Amanda Marie Sebring, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 1001 Blythe Blvd, Medical Center Plaza Suite 200, Charlotte, NC 28203 Phone: 704-381-8840 | |
Fnu Pardeep, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 14214 Ballantyne Lake Rd, Ste 300, Charlotte, NC 28277 Phone: 704-667-2600 | |
Nicole Ludmil Ivanov, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 9908 Couloak Dr, Ste 103, Charlotte, NC 28216 Phone: 704-801-2025 | |
Dr. Kathy Garland Mohanty, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 6324 Fairview Rd Ste 350, Charlotte, NC 28210 Phone: 704-384-8600 Fax: 704-384-8610 | |
Dr. Meredith Givens Pochick, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 3129 Springbank Ln Ste 100, Charlotte, NC 28226 Phone: 704-384-5151 Fax: 704-316-2905 | |
Donald Shelton Chapman Jr., MD Pediatrics Medicare: Medicare Enrolled Practice Location: 231 S Sharon Amity Rd, Charlotte, NC 28211 Phone: 704-304-6400 |