Provider Demographics
NPI:1093891608
Name:BOSJOLIE, ANGELA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LYNN
Last Name:BOSJOLIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2514
Mailing Address - Country:US
Mailing Address - Phone:203-574-2020
Mailing Address - Fax:032-596-2230
Practice Address - Street 1:87 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2514
Practice Address - Country:US
Practice Address - Phone:203-574-2020
Practice Address - Fax:032-596-2230
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53988207W00000X
VA0102203446207W00000X
MDH0075997207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
U96115Medicare UPIN