Provider Demographics
NPI:1932244969
Name:BOISE, MARINA (PA)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:BOISE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:RHODES-BOISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5370 SEDALIA CIR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:216-577-8540
Mailing Address - Fax:
Practice Address - Street 1:5008 BRITTONFIELD PKWY STE 700
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9249
Practice Address - Country:US
Practice Address - Phone:315-472-7504
Practice Address - Fax:315-634-4677
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110010350363AM0700X
NY020915363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020915OtherNYS LICENSE