Healthcare Provider Details

I. General information

NPI: 1720669914
Provider Name (Legal Business Name): MADELINE BOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E PALM VALLEY BLVD STE 240
ROUND ROCK TX
78664-3043
US

IV. Provider business mailing address

505 E PALM VALLEY BLVD STE 240
ROUND ROCK TX
78664-3043
US

V. Phone/Fax

Practice location:
  • Phone: 844-824-8775
  • Fax:
Mailing address:
  • Phone: 844-824-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberV9282
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: