Individual
JERROLD L BOXERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-5174
(401) 453-8220
Mailing address
125 METRO CENTER BLVD STE 2000, WARWICK, RI 02886-1785
(401) 432-2520
(401) 453-8220
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
213422
MA
2085R0202X
Diagnostic Radiology Physician
Primary
MD10844
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003117331
CT MED ASSISTANCE
—
01
—
007009871
HOSPITAL PIN
—
01
—
010844
TUFTS
—
01
—
0184900
MASSMEDICAID
—
01
—
050318025
UNICARE
—
01
—
16 50203
UNITED HEALTH PLANS
—
01
—
243634
RIH PILGRIM
—
01
—
300131996
RAILROAD MEDICARE
—
01
—
409911
BLUE CHIP SENIORS
—
01
—
7009870
RI MEDICAL ASSISTANCE
—
01
—
7767985003
CIGNA
—
01
—
80744
BLUE SHIELD
—
Enumeration date
11/02/2005
Last updated
03/15/2024
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