Provider Demographics
NPI:1871648204
Name:BOSENBERG, CAROLA E (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLA
Middle Name:E
Last Name:BOSENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1611 116TH AVE NE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3045
Mailing Address - Country:US
Mailing Address - Phone:425-454-3100
Mailing Address - Fax:425-454-3101
Practice Address - Street 1:1611 116TH AVE NE
Practice Address - Street 2:SUITE 218
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3045
Practice Address - Country:US
Practice Address - Phone:425-454-3100
Practice Address - Fax:425-454-3101
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA262742084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA202124OtherVALUE OPTIONS
WA00547255OtherAETNA
WA1610BOOtherREGENCE BLUE SHIELD