MEDICARE: NEDA RIAHI VANDEN BOSCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	ME85257	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568491009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEDA RIAHI VANDEN BOSCH MD

Provider Business Mailing Address
First Line	:	3618 LANTANA RD STE 101
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-2247
Country	:	US
Telephone Number	:	561-357-2020
Fax Number	:	561-357-2022

Provider Business Practice Location Address
First Line	:	3618 LANTANA RD STE 101
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-2247
Country	:	US
Telephone Number	:	561-357-2020
Fax Number	:	561-357-2022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	05/15/2021

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