Individual
SHANE P BOSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1970 ROANOKE BLVD, SALEM, VA 24153-6404
(540) 982-2463
(540) 983-1093
Mailing address
1970 ROANOKE BLVD, SALEM, VA 24153-6404
(540) 982-2463
(540) 983-1093
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101236539
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010166403
—
VA
Enumeration date
05/18/2006
Last updated
11/22/2012
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