Basic Information
| Provider Information | |||||||||
| NPI: | 1073591061 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOSKEN | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751803 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364757163 | ||||||||
| FaxNumber: | 3364751199 | ||||||||
| Practice Location | |||||||||
| Address1: | 903 RANDOLPH ST | ||||||||
| Address2: | DBA CHAIR CITY FAMILY PRACTICE/MEDZONE | ||||||||
| City: | THOMASVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273605898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364757163 | ||||||||
| FaxNumber: | 3364751199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 02/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21538 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00247946 | 01 | NC | RAILROAD MEDICARE | OTHER | 8916996 | 05 | NC | MEDICAID |