Provider Demographics
NPI:1437173507
Name:BOSCHA, KENNETH W (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:BOSCHA
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 1:508 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1702
Mailing Address - Country:US
Mailing Address - Phone:724-547-1405
Mailing Address - Fax:724-547-1289
Practice Address - Street 1:508 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1702
Practice Address - Country:US
Practice Address - Phone:724-547-1405
Practice Address - Fax:724-547-1289
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030863E207RC0000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010065370003Medicaid
E55480Medicare UPIN
PA0010065370003Medicaid