Provider Demographics
NPI:1124075544
Name:ROSEN, BOAZ DOV (MD)
Entity type:Individual
Prefix:
First Name:BOAZ
Middle Name:DOV
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:201 DEFENSE HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8943
Mailing Address - Country:US
Mailing Address - Phone:443-481-3354
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-224-0040
Practice Address - Fax:410-224-4232
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2017-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD72843207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD045005700Medicaid
MDAT540007OtherBCBS
MD225678Y5ZMedicare PIN