Individual
DR. JOSE S BOSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.,CMD
Contact information
Practice address
3704 EGERTON RD, BALTIMORE, MD 21215-7115
(410) 367-5880
Mailing address
5401 OLD COURT RD, ATTN: CREDENTIALING, RANDALLSTOWN, MD 21133-5103
(410) 601-5524
(410) 601-8946
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D28462
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110168890
R/R MEDICARE PROVIDER #
MD
01
—
CN6601
R/R MEDICARE GROUP #
MD
Enumeration date
03/31/2006
Last updated
03/08/2010
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