Provider Demographics
NPI:1093930133
Name:RIDA, BOSHRA MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:BOSHRA
Middle Name:MOHAMMED
Last Name:RIDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 Q ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3609
Mailing Address - Country:US
Mailing Address - Phone:402-421-0904
Mailing Address - Fax:402-421-0946
Practice Address - Street 1:2200 S 40TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2425
Practice Address - Country:US
Practice Address - Phone:402-483-6000
Practice Address - Fax:402-483-6106
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0001684207Q00000X
NE24739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01629OtherBCBS
NE0922940005Medicare PIN
NE098147012Medicare PIN
NEP00758084Medicare PIN
NE01629OtherBCBS