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NPI Code Detail

MEDICARE: MARK P VANDEN BOSCH MD

MEDICARE: MARK P VANDEN BOSCH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician214246MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336132521
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK P VANDEN BOSCH MD
Provider Business Mailing Address
First Line : 100 NORTH ST
Second Line : STE 413
City : PITTSFIELD
State : MA
Zip : 01201-5109
Country : US
Telephone Number : 413-447-2555
Fax Number : 413-443-7039
Provider Business Practice Location Address
First Line : 725 NORTH ST
Second Line : BERKSHIRE MEDICAL CENTER
City : PITTSFIELD
State : MA
Zip : 01201-4132
Country : US
Telephone Number : 413-447-2555
Fax Number : 413-443-7039
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 07/08/2007

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Directions to “ MARK P VANDEN BOSCH MD” Practice Location

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