Provider Demographics
NPI:1215232541
Name:JULIUS BOATENG MD PC
Entity Type:Organization
Organization Name:JULIUS BOATENG MD PC
Other - Org Name:JULIUS BOATENG MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-325-1278
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:304
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-325-1278
Mailing Address - Fax:443-836-0405
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:304
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-325-1278
Practice Address - Fax:443-836-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD085RMedicare PIN