Provider Demographics
NPI:1578527396
Name:BOADA, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BOADA
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 1:1 RODRIGUEZ SERRA ST #401
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1496
Mailing Address - Country:US
Mailing Address - Phone:787-251-5280
Mailing Address - Fax:787-785-3617
Practice Address - Street 1:1845 CARR 2 STE 810
Practice Address - Street 2:BAYAMON MEDICAL PLAZA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7206
Practice Address - Country:US
Practice Address - Phone:787-251-5280
Practice Address - Fax:787-785-3617
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13255207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22067Medicare PIN
PR85242Medicare PIN
H43688Medicare UPIN