Provider Demographics
NPI:1285619155
Name:BOERSTLING, HERBERT (MD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:
Last Name:BOERSTLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8053
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:333 LONGWOOD AVE
Practice Address - Street 2:CHILDREN'S HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5711
Practice Address - Country:US
Practice Address - Phone:617-355-8732
Practice Address - Fax:617-277-8934
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31636208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPP104OtherHARVARD PILGRIM HEALTH
MAB11441OtherBLUE CROSS
MA0023650OtherNEIGHBORHOOD HEALTH PLAN
MA0130699Medicaid
MA031636OtherTUFTS HEALTH PLAN
MA8090525-002OtherCIGNA
MA031636OtherTUFTS HEALTH PLAN
MAB11441Medicare ID - Type Unspecified