Individual
PHILIP J. BOSHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
143 HOSPITAL DR STE 112, STATE COLLEGE, PA 16803-5500
(814) 865-3566
(814) 863-7803
Mailing address
PO BOX 858, MC A410, HERSHEY, PA 17033-0858
(800) 243-1455
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
L9632
TX
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
MD420020
PA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD420020
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016695050001
—
PA
01
—
103542NZ3
MEDICARE
PA
05
—
173210901
—
TX
Enumeration date
01/05/2006
Last updated
08/15/2025
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