Provider Demographics
NPI:1699790824
Name:BOSE, TERESA MARIE (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:BOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1942
Mailing Address - Country:US
Mailing Address - Phone:781-721-4701
Mailing Address - Fax:781-729-5262
Practice Address - Street 1:1021 MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1942
Practice Address - Country:US
Practice Address - Phone:781-721-4701
Practice Address - Fax:781-729-5262
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA212227207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ24250OtherBLUE SHIELD
MA0155250Medicaid
MAA3288401Medicare PIN
MA0155250Medicaid
MAA32884Medicare PIN