Individual
ANDREW BOSTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, APC 9, PROVIDENCE, RI 02903-4923
(401) 444-6460
(401) 444-2217
Mailing address
PO BOX 1358, PROVIDENCE, RI 02901-1358
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD09437
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2100339
—
MA
05
—
9025311
—
RI
01
—
P00024512
RAILROAD MEDICARE
RI
Enumeration date
05/20/2006
Last updated
08/05/2008
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