Provider Demographics
NPI:1104209972
Name:BOSCH, MARIE A (MD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:A
Last Name:BOSCH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:13975 MANCHESTER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4500
Mailing Address - Country:US
Mailing Address - Phone:314-312-2234
Mailing Address - Fax:888-336-4072
Practice Address - Street 1:13975 MANCHESTER RD STE 2
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4500
Practice Address - Country:US
Practice Address - Phone:314-312-2234
Practice Address - Fax:888-336-4072
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2025-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20180142042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200062351Medicaid