Provider Demographics
NPI:1780046441
Name:BOECKING, CAROLIN ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLIN
Middle Name:ANNE
Last Name:BOECKING
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 1:850 THORNTON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4702
Mailing Address - Country:US
Mailing Address - Phone:408-793-1900
Mailing Address - Fax:
Practice Address - Street 1:850 THORNTON WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4702
Practice Address - Country:US
Practice Address - Phone:408-793-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI20-018207ZP0101X
MIS-21-314207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology