Provider Demographics
NPI:1255447959
Name:LIM, BOON
Entity type:Individual
Prefix:DR
First Name:BOON
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 THORNTON RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4800
Mailing Address - Country:US
Mailing Address - Phone:410-967-4393
Mailing Address - Fax:410-823-1364
Practice Address - Street 1:8503 THORNTON RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4800
Practice Address - Country:US
Practice Address - Phone:410-967-4393
Practice Address - Fax:410-823-1364
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37254207R00000X
PAMD435831207R00000X, 2083P0901X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA117611OtherGEISINGER HEALTH PLAN
PA20090433OtherAMERIHEALTH MERCY-WMG
PA50082107OtherCAPITAL BLUE CROSS-WMG
MD125361101Medicaid
MD531317OtherCAREFIRST MD BCBS
PA258747OtherUNISON-WMG
PA6726533OtherAETNA
PA018105OtherJOHNS HOPKINS
PA1550632OtherGATEWAY-WMG
PA689005OtherHIGHMARK BLUE SHIELD
PA102237934Medicaid
PAP00805700Medicare PIN
MD125361101Medicaid
PA139279FLTMedicare PIN