Provider Demographics
NPI:1831573179
Name:JULIUS BOATENG, M.D. PC
Entity type:Organization
Organization Name:JULIUS BOATENG, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIA
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-466-5323
Mailing Address - Street 1:PO BOX 26587
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-0387
Mailing Address - Country:US
Mailing Address - Phone:410-466-5323
Mailing Address - Fax:410-466-5130
Practice Address - Street 1:2411 W BELVEDERE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5228
Practice Address - Country:US
Practice Address - Phone:410-466-5323
Practice Address - Fax:410-466-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD46267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD230103200Medicaid
MD085RMedicare PIN