Basic Information
| Provider Information | |||||||||
| NPI: | 1538150008 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOXERMAN | ||||||||
| FirstName: | JERROLD | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 METRO CENTER BLVD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4014538220 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 METRO CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4014538220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 03/14/2019 | ||||||||
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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 | 2085R0202X | 10844 | RI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD10844 | RI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 003117331 | 01 | CT MED ASSISTANCE | OTHER | 243634 | 01 | RIH PILGRIM | OTHER | 409911 | 01 | BLUE CHIP | OTHER | 80744 | 01 | BLUE SHIELD | OTHER | 007009871 | 01 | HOSPITAL PIN | OTHER | 0184900 | 01 | MASSMEDICAID | OTHER | 16 50203 | 01 | UNITED HEALTH PLANS | OTHER | 300131996 | 01 | RAILROAD MEDICARE | OTHER | 7009870 | 01 | RI MEDICAL ASSISTANCE | OTHER | 7767985003 | 01 | CIGNA | OTHER | 010844 | 01 | TUFTS | OTHER | 050318025 | 01 | UNICARE | OTHER | 409911 | 01 | BLUE CHIP SENIORS | OTHER |