Healthcare Provider Details

I. General information

NPI: 1760450662
Provider Name (Legal Business Name): CHRISTOPHER S BOSWELL IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS GUNSTON HALL LSD 44
FPO AE
09573-1732
US

IV. Provider business mailing address

604 GREEN OAKS CT
CHESAPEAKE VA
23322-5867
US

V. Phone/Fax

Practice location:
  • Phone: 757-462-7491
  • Fax:
Mailing address:
  • Phone: 228-229-7121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: