Provider Demographics
NPI:1073591061
Name:BOSKEN, DONALD W (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:BOSKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-475-7163
Mailing Address - Fax:336-475-1199
Practice Address - Street 1:903 RANDOLPH ST
Practice Address - Street 2:DBA CHAIR CITY FAMILY PRACTICE/MEDZONE
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5898
Practice Address - Country:US
Practice Address - Phone:336-475-7163
Practice Address - Fax:336-475-1199
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00247946OtherRAILROAD MEDICARE
NC8916996Medicaid
NC8916996Medicaid
NC201774FMedicare PIN
C80887Medicare UPIN
NC201774HMedicare PIN