Provider Demographics
NPI:1659314599
Name:BOARDMAN, NORMAN DOUGLAS III (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:DOUGLAS
Last Name:BOARDMAN
Suffix:III
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:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:DOSWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23047-0240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MCV/VCU DEPARTMENT OF ORTHOPAEDICS
Practice Address - Street 2:BOX 980153
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0153
Practice Address - Country:US
Practice Address - Phone:804-828-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227814207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G51622Medicare UPIN