Provider Demographics
NPI:1811980931
Name:BOSKOVSKA, OLIVERA B (MD)
Entity type:Individual
Prefix:DR
First Name:OLIVERA
Middle Name:B
Last Name:BOSKOVSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:OLIVERA
Other - Middle Name:BRANISLAV
Other - Last Name:KAJEVSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:110 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5674
Mailing Address - Country:US
Mailing Address - Phone:508-894-0400
Mailing Address - Fax:508-894-0412
Practice Address - Street 1:110 LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-894-0400
Practice Address - Fax:508-894-0412
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005001986207Q00000X
MA252624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209007210Medicaid
MO2099007202Medicaid
MO209007210Medicaid
MO209007210Medicaid