Healthcare Provider Details

I. General information

NPI: 1447937784
Provider Name (Legal Business Name): KATHRYN P BOSWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 W UNDERWOOD ST # MP31
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

52 W UNDERWOOD ST # MP31
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-5210
  • Fax: 407-237-6313
Mailing address:
  • Phone: 407-841-5210
  • Fax: 407-237-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME180844
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: