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General NPI Number Information
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NPI Number | 1356617781
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Entity Type | Organization
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Legal Business Name | CALVIN JONATHAN BOSMAN LLC
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 4 CARRIAGE LN SUITE 300-C
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City | CHARLESTON
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State | SC
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Zip | 29407-6065
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Country | US
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Telephone | 843-906-7728
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Fax |
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Provider Business Mailing Address
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Address Line | 26 MOORE DR
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City | CHARLESTON
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State | SC
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Zip | 29407-7230
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Country | US
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Telephone | 843-906-7728
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. CALVIN JONATHAN BOSMAN
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Credential | MD
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Telephone | 843-906-7728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 28183
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License Number State | SC
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