Provider Demographics
NPI:1992752257
Name:BOSSE, MYHANH T (MD)
Entity type:Individual
Prefix:DR
First Name:MYHANH
Middle Name:T
Last Name:BOSSE
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 1:1095 RYDAL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1711
Mailing Address - Country:US
Mailing Address - Phone:267-620-1100
Mailing Address - Fax:215-572-1279
Practice Address - Street 1:1095 RYDAL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-1711
Practice Address - Country:US
Practice Address - Phone:267-620-1100
Practice Address - Fax:215-572-1279
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041827207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1164254OtherKEYSTONE MERCY
PA14617OtherHEALTH PARTNERS
PA231937219OtherMULTIPLAN
PA1035370OtherCIGNA
PA4310327OtherAETNA
PAP386838OtherOXFORD
PA0643720000OtherKEYASTONE EAST
PA000739575OtherAMERIHEALTH
PA000739575OtherHIGHMARK BLUE SHIELD
PA231937219OtherDEVON
PA231937219OtherFIRST HEALTH
PA0014074650006Medicaid
PA100006781OtherPALMETTO GBA
PA231937219OtherTRICARE
PA000739575OtherPERSONAL CHOICE
PA1164254OtherKEYSTONE MERCY