Provider Demographics
NPI:1740664341
Name:BOCSKOR, KATHLEEN (NP- FAMILY)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BOCSKOR
Suffix:
Gender:F
Credentials:NP- FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 DUNDALK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-3714
Mailing Address - Country:US
Mailing Address - Phone:410-288-4800
Mailing Address - Fax:
Practice Address - Street 1:2112 DUNDALK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-3714
Practice Address - Country:US
Practice Address - Phone:410-288-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220716363LF0000X, 163W00000X
NY686422-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse