Provider Demographics
NPI:1710322854
Name:BOSLEY MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:BOSLEY MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:WASHENIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:310-288-9999
Mailing Address - Street 1:9100 WILSHIRE BLVD
Mailing Address - Street 2:EAST TOWER PENTHOUSE
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3415
Mailing Address - Country:US
Mailing Address - Phone:310-288-4410
Mailing Address - Fax:310-734-1517
Practice Address - Street 1:545 BOYLSTON ST
Practice Address - Street 2:PENTHOUSE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3606
Practice Address - Country:US
Practice Address - Phone:617-375-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty