Edward R Boshoff
Individual provider Active NPI Counselor · Laplata, MD
NPI 1780836668 · NPPES record last updated Oct 22, 2008
Key facts
- NPI
- 1780836668
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 6100 Radio Station Road
Laplata, MD 20646 - Phone
- (301) 609-9887
- Fax
- (301) 609-7284
- NPI assigned
- Oct 22, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
6100 Radio Station Road
Laplata, MD 20646
Mailing address
PO Box 2924
La Plata, MD 20646-2984
Phone (301) 609-9887
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 58956180 | Medicaid | MD |
Other providers in Laplata, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.