Provider Demographics
NPI:1568491009
Name:VANDEN BOSCH, NEDA RIAHI (MD)
Entity Type:Individual
Prefix:
First Name:NEDA
Middle Name:RIAHI
Last Name:VANDEN BOSCH
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 1:3618 LANTANA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2247
Mailing Address - Country:US
Mailing Address - Phone:561-357-2020
Mailing Address - Fax:561-357-2022
Practice Address - Street 1:3618 LANTANA RD STE 101
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-2247
Practice Address - Country:US
Practice Address - Phone:561-357-2020
Practice Address - Fax:561-357-2022
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME852572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7603Medicare PIN
H64283Medicare UPIN