Provider Demographics
NPI:1992767495
Name:BOSWELL, MARK V (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:V
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3355 GLENDALE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-6699
Mailing Address - Fax:419-383-3378
Practice Address - Street 1:1125 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614
Practice Address - Country:US
Practice Address - Phone:419-383-6699
Practice Address - Fax:419-383-3378
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY43774207L00000X
OH35.054673207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200992590Medicaid
KY7100148990Medicaid
IN200992590Medicaid