Provider Demographics
NPI:1689804965
Name:BOSCO, ANDREA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:BOSCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:BOSCO
Other - Last Name:KAKOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2123 AUBURN AVE
Mailing Address - Street 2:MEDICAL OFFICE BUILDING, SUITE 307
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-585-3474
Mailing Address - Fax:513-585-4895
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:MEDICAL OFFICE BUILDING, SUITE 307
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-3474
Practice Address - Fax:513-585-4895
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program