Provider Demographics
NPI:1336132521
Name:VANDEN BOSCH, MARK P (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:VANDEN BOSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 NORTH ST
Mailing Address - Street 2:STE 413
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5109
Mailing Address - Country:US
Mailing Address - Phone:413-447-2555
Mailing Address - Fax:413-443-7039
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:BERKSHIRE MEDICAL CENTER
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4132
Practice Address - Country:US
Practice Address - Phone:413-447-2555
Practice Address - Fax:413-443-7039
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA214246207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0180807Medicaid
MA0180807Medicaid
MAA34511Medicare ID - Type Unspecified