Provider Demographics
NPI:1003919507
Name:CICERONE BOSSARD, VALERIE J (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:J
Last Name:CICERONE BOSSARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:J
Other - Last Name:CICERONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8001 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PHILADELPHI
Mailing Address - State:PA
Mailing Address - Zip Code:19152
Mailing Address - Country:US
Mailing Address - Phone:215-332-8870
Mailing Address - Fax:215-332-0810
Practice Address - Street 1:8001 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:PHILADELPHI
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:215-332-8870
Practice Address - Fax:215-332-0810
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022661E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B41304Medicare UPIN
059694Medicare ID - Type Unspecified