Provider Demographics
NPI:1548572803
Name:BOSSE, KRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:
Last Name:BOSSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:34TH ST. & CIVIC CENTER BLVD
Mailing Address - Street 2:THE CHILDREN'S HOSPITAL OF PHILADELPHIA, ROOM 9NW55
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4399
Mailing Address - Country:US
Mailing Address - Phone:215-590-2437
Mailing Address - Fax:215-590-2768
Practice Address - Street 1:34TH ST. & CIVIC CENTER BLVD
Practice Address - Street 2:THE CHILDREN'S HOSPITAL OF PHILADELPHIA, ROOM 9NW55
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4399
Practice Address - Country:US
Practice Address - Phone:215-590-2437
Practice Address - Fax:215-590-2768
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT196887208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics