Provider Demographics
NPI:1740372747
Name:BOATENG, JOSHUA YAW (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:YAW
Last Name:BOATENG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 49047
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-9047
Mailing Address - Country:US
Mailing Address - Phone:215-242-2200
Mailing Address - Fax:215-242-2200
Practice Address - Street 1:1400 E MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-2004
Practice Address - Country:US
Practice Address - Phone:215-242-2200
Practice Address - Fax:215-242-2200
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002822L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001003357 0005Medicaid
PAT29224Medicare UPIN
PA119585Medicare ID - Type Unspecified