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NPI Code Detail

MEDICARE: MADELINE BOS MD

MEDICARE: MADELINE BOS 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
1390200000XStudent in an Organized Health Care Education/Training Program
22084P0800XPsychiatry PhysicianV9282TX

General Provider Information

NPI Number : 1720669914
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELINE BOS MD
Provider Business Mailing Address
First Line : 505 E PALM VALLEY BLVD STE 240
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-3043
Country : US
Telephone Number : 844-824-8775
Fax Number :
Provider Business Practice Location Address
First Line : 505 E PALM VALLEY BLVD STE 240
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-3043
Country : US
Telephone Number : 844-824-8775
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2021
Last Update Date : 05/19/2026

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