Provider Demographics
NPI:1538150008
Name:BOXERMAN, JERROLD L (MD)
Entity type:Individual
Prefix:
First Name:JERROLD
Middle Name:L
Last Name:BOXERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-453-8220
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-5174
Practice Address - Fax:401-453-8220
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2134222085R0202X
RIMD108442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0184900OtherMASSMEDICAID
7009870OtherRI MEDICAL ASSISTANCE
050318025OtherUNICARE
300131996OtherRAILROAD MEDICARE
003117331OtherCT MED ASSISTANCE
007009871OtherHOSPITAL PIN
243634OtherRIH PILGRIM
80744OtherBLUE SHIELD
16 50203OtherUNITED HEALTH PLANS
409911OtherBLUE CHIP SENIORS
7767985003OtherCIGNA
010844OtherTUFTS
409911OtherBLUE CHIP