Provider Demographics
NPI:1598837700
Name:BOEHM, ROSEMARIE (MD)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:BOEHM
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:PO BOX 8500-8735
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-254-2599
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-7900
Practice Address - Fax:215-456-5948
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06079800207QS0010X
PAMD419220207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2458042OtherCIGNA
PA2845979000OtherIBC PA
NJ5551738OtherAETNA
NJ2081676000OtherIBC NJ
NJ5551738OtherAETNA
NJ2458042OtherCIGNA
PA058460GC6Medicare PIN
PA2845979000OtherIBC PA
NJP00388234Medicare PIN