Provider Demographics
NPI:1447594387
Name:BOHA, MARIA AGNES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:AGNES
Last Name:BOHA
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 1:5016 S SKYLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119
Mailing Address - Country:US
Mailing Address - Phone:812-945-4159
Mailing Address - Fax:
Practice Address - Street 1:5016 S SKYLINE DRIVE
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119
Practice Address - Country:US
Practice Address - Phone:812-945-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01019727A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine