Provider Demographics
NPI:1790977759
Name:BOEHM, MARILYN JEAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:JEAN
Last Name:BOEHM
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 E IVYBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUBERT
Mailing Address - State:NC
Mailing Address - Zip Code:28539-4462
Mailing Address - Country:US
Mailing Address - Phone:252-646-3338
Mailing Address - Fax:
Practice Address - Street 1:152 E IVYBRIDGE DR
Practice Address - Street 2:104
Practice Address - City:HUBERT
Practice Address - State:NC
Practice Address - Zip Code:28539-4462
Practice Address - Country:US
Practice Address - Phone:910-219-1339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine