Provider Demographics
NPI:1104307834
Name:MED MGT ASSOCIATES OF VIRGINIA LLC
Entity type:Organization
Organization Name:MED MGT ASSOCIATES OF VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOSKIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-224-2106
Mailing Address - Street 1:7272 WURZBACH RD STE 601
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4803
Mailing Address - Country:US
Mailing Address - Phone:210-615-3483
Mailing Address - Fax:
Practice Address - Street 1:688 KINGSBOROUGH SQ
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4908
Practice Address - Country:US
Practice Address - Phone:757-547-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012652222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101265222OtherLICENSE