Provider Demographics
NPI:1093796559
Name:BOATENG, JULIUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIUS
Middle Name:
Last Name:BOATENG
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 1:2791 WYNFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WEST FRIENDSHIP
Mailing Address - State:MD
Mailing Address - Zip Code:21794-9520
Mailing Address - Country:US
Mailing Address - Phone:410-466-5323
Mailing Address - Fax:410-466-5130
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:STE 201
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-466-5323
Practice Address - Fax:410-466-5130
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD46267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD230103200Medicaid
MDT29224Medicare UPIN
MD085RMedicare PIN