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General NPI Number Information
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NPI Number | 1649266412
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Entity Type | Individual
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Provider Name | EDWIN BRIAN BOSO M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 800 GARFIELD AVE
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City | PARKERSBURG
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State | WV
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Zip | 26101-5376
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Country | US
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Telephone | 304-424-2590
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Fax | 304-422-3924
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Provider Business Mailing Address
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Address Line | 601 AVERY ST STE 501
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City | PARKERSBURG
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State | WV
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Zip | 26101-5192
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Country | US
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Telephone | 304-422-3904
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Fax | 304-422-3924
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 35070251
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 15116
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License Number State | WV
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