Provider Demographics
NPI:1962402107
Name:BOSTON, BARRY (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:BOSTON
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 1:7945 WOLF RIVER BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1762
Mailing Address - Country:US
Mailing Address - Phone:901-767-4520
Mailing Address - Fax:901-684-2515
Practice Address - Street 1:7945 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1762
Practice Address - Country:US
Practice Address - Phone:901-767-4520
Practice Address - Fax:901-684-2515
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10091207RH0003X
MS16847207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101748001Medicaid
4020364OtherAETNA
TN2004579OtherBLUE CROSS BLUE SHIELD
2694685OtherCIGNA
MS00123757Medicaid
119722OtherBETTER HEALTH TNCARE
TN3163546Medicaid
3000094OtherTLC TNCARE
2694685OtherCIGNA
B06014Medicare UPIN
TN3163546Medicaid