MEDICARE: MICHAEL JOSEPH BOERGER MS

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	103T00000X	Psychologist	PS005610L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50035024	OTHER	PA	CAPITAL BLUE CROSS
2	701979	OTHER	PA	HIGHMARK BS

General Provider Information

NPI Number	:	1720067184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOSEPH BOERGER MS

Provider Business Mailing Address
First Line	:	2141 OREGON PIKE
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601-4604
Country	:	US
Telephone Number	:	717-560-7917
Fax Number	:	717-560-6452

Provider Business Practice Location Address
First Line	:	2141 OREGON PIKE
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601-4604
Country	:	US
Telephone Number	:	717-560-7917
Fax Number	:	717-560-6452

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	12/18/2007

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