Provider Demographics
NPI:1386741577
Name:BOSE, BIKASH (MD)
Entity type:Individual
Prefix:DR
First Name:BIKASH
Middle Name:
Last Name:BOSE
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:C 79 OMEGA DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-738-9145
Mailing Address - Fax:302-738-9148
Practice Address - Street 1:C 79 OMEGA DRIVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-738-9145
Practice Address - Fax:302-738-9148
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002577207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000033801Medicaid
000B32N33Medicare ID - Type Unspecified
DE0000033801Medicaid
DE1219370001Medicare NSC