Healthcare Provider Details

I. General information

NPI: 1740286509
Provider Name (Legal Business Name): CAROL A BOERSMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 04/18/2020
Certification Date: 04/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RIO EAST CT STE A
CHARLOTTESVILLE VA
22901-8040
US

IV. Provider business mailing address

900 RIO EAST CT STE A
CHARLOTTESVILLE VA
22901-8040
US

V. Phone/Fax

Practice location:
  • Phone: 434-975-7777
  • Fax: 434-975-7774
Mailing address:
  • Phone: 434-975-7777
  • Fax: 434-975-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101238260
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: